Provider Demographics
NPI:1164542940
Name:GOZO, FELIX ROSEL JR (MD)
Entity Type:Individual
Prefix:
First Name:FELIX
Middle Name:ROSEL
Last Name:GOZO
Suffix:JR
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 1:1320 INVERNESS LANE
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375
Mailing Address - Country:US
Mailing Address - Phone:219-322-9437
Mailing Address - Fax:
Practice Address - Street 1:1354 S LAKE PARK AVENUE
Practice Address - Street 2:ST MARYS SPECTRUM REHAB CENTER CARDIAC
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342
Practice Address - Country:US
Practice Address - Phone:219-947-6089
Practice Address - Fax:219-947-6356
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033486A208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
D69807Medicare UPIN
IN875160BMedicare ID - Type Unspecified