MEDICARE: DR. WENDELL JOSEPH GORUM II 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
1	207X00000X	Orthopaedic Surgery Physician	248330	NY

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	:	1659379469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WENDELL JOSEPH GORUM II MD

Provider Business Mailing Address
First Line	:	1503 GRAVESEND NECK RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4428
Country	:	US
Telephone Number	:	718-479-3303
Fax Number	:	646-569-6993

Provider Business Practice Location Address
First Line	:	1503 GRAVESEND NECK RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4428
Country	:	US
Telephone Number	:	718-479-3303
Fax Number	:	646-569-6993

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	04/19/2016

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