MEDICARE: CONSULTANTS IN GASTROENTEROLOGY INC

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
1	207RG0100X	Gastroenterology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578663522
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONSULTANTS IN GASTROENTEROLOGY INC

Provider Business Mailing Address
First Line	:	5900 LANDERBROOK DR
Second Line	:	SUITE 203
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-4020
Country	:	US
Telephone Number	:	440-461-2550
Fax Number	:

Provider Business Practice Location Address
First Line	:	5900 LANDERBROOK DR
Second Line	:	SUITE 190
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-4020
Country	:	US
Telephone Number	:	440-461-2550
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAVID GOTTESMAN
Credential	:	MD
Telephone Number	:	440-461-2550

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	10/10/2012

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