MEDICARE: DR. MICHAEL JOHN GORZ OD

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	152W00000X	Optometrist	3514-35	WI

General Provider Information

NPI Number	:	1750867149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JOHN GORZ OD

Provider Business Mailing Address
First Line	:	1021 JEFFERSON ST
Second Line	:
City	:	ALGOMA
State	:	WI
Zip	:	54201-1737
Country	:	US
Telephone Number	:	920-487-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	1021 JEFFERSON ST
Second Line	:
City	:	ALGOMA
State	:	WI
Zip	:	54201-1737
Country	:	US
Telephone Number	:	920-487-2020
Fax Number	:

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

Provider Enumeration Date	:	07/18/2018
Last Update Date	:	07/18/2018

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