Provider Demographics
NPI:1013001908
Name:GOSHGARIAN, GERARD MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:MARTIN
Last Name:GOSHGARIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N GREENLEAF ST
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3326
Mailing Address - Country:US
Mailing Address - Phone:847-244-4343
Mailing Address - Fax:847-244-8111
Practice Address - Street 1:105 N GREENLEAF ST
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3326
Practice Address - Country:US
Practice Address - Phone:847-244-4343
Practice Address - Fax:847-244-8111
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04900741OtherBCBS OF ILLINOIS
K34153Medicare PIN
0515420001Medicare NSC