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NPI Code Detail

MEDICARE: MAXIM GORELIK MD

MEDICARE:   MAXIM  GORELIK  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P2900XPain Medicine (Psychiatry & Neurology) PhysicianA082703CA
22084P2900XPain Medicine (Psychiatry & Neurology) Physician49603WI
32084P2900XPain Medicine (Psychiatry & Neurology) Physician49603-20WI

General Provider Information

NPI Number : 1548246101
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAXIM GORELIK MD
Provider Business Mailing Address
First Line : 1000 MINERAL POINT AVE
Second Line :
City : JANESVILLE
State : WI
Zip : 53548-2940
Country : US
Telephone Number : 608-756-6826
Fax Number : 608-756-6160
Provider Business Practice Location Address
First Line : 1000 MINERAL POINT AVE
Second Line :
City : JANESVILLE
State : WI
Zip : 53548-2940
Country : US
Telephone Number : 608-756-6826
Fax Number : 608-756-6160
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2005
Last Update Date : 08/14/2013

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