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NPI Code Detail

MEDICARE: DR. CHARLES OZAK GONIK M.D.

MEDICARE: DR. CHARLES OZAK GONIK M.D.
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
1207V00000XObstetrics & Gynecology PhysicianME69198FL
2207V00000XObstetrics & Gynecology Physician4301045929MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962452789
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES OZAK GONIK M.D.
Provider Business Mailing Address
First Line : 2520 S TELEGRAPH RD
Second Line : SUITE 200
City : BLOOMFIELD HILLS
State : MI
Zip : 48302-0285
Country : US
Telephone Number : 248-335-9207
Fax Number : 248-335-2394
Provider Business Practice Location Address
First Line : 225 S CONGRESS AVE
Second Line :
City : DELRAY BEACH
State : FL
Zip : 33445-4616
Country : US
Telephone Number : 561-274-3100
Fax Number : 561-837-5332
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2006
Last Update Date : 04/11/2014

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