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NPI Code Detail

MEDICARE: ANDREW WILLIAM GORDON MD

MEDICARE: ANDREW WILLIAM GORDON 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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1821933771
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW WILLIAM GORDON MD
Provider Business Mailing Address
First Line : 14601 DETROIT AVE
Second Line :
City : LAKEWOOD
State : OH
Zip : 44107-4205
Country : US
Telephone Number : 216-237-5500
Fax Number :
Provider Business Practice Location Address
First Line : 14601 DETROIT AVE
Second Line :
City : LAKEWOOD
State : OH
Zip : 44107-4205
Country : US
Telephone Number : 216-237-5500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2026
Last Update Date : 04/20/2026

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