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NPI Code Detail

MEDICARE: DR MITCHELL GOOZDICH INC

MEDICARE: DR MITCHELL GOOZDICH 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
1111N00000XChiropractor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000257029OTHEROHANTHEM BLUE CROSS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720073257
Entity Type Code : Organization
Provider Name (Legal Business Name) : DR MITCHELL GOOZDICH INC
Provider Business Mailing Address
First Line : 113 N LEAVITT RD
Second Line :
City : AMHERST
State : OH
Zip : 44001-1110
Country : US
Telephone Number : 440-985-5505
Fax Number : 440-985-5507
Provider Business Practice Location Address
First Line : 113 N LEAVITT RD
Second Line :
City : AMHERST
State : OH
Zip : 44001-1110
Country : US
Telephone Number : 440-985-5505
Fax Number : 440-985-5507
Authorized Official
Title or Position : PRESIDENT
Name : MITCHELL GOOZDICH
Credential : DC
Telephone Number : 440-985-5505
Provider Enumeration Date : 09/12/2005
Last Update Date : 08/27/2007

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Directions to “DR MITCHELL GOOZDICH INC ” Practice Location

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