Provider Demographics
NPI:1457323123
Name:GORIN, MICHAEL EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EDWARD
Last Name:GORIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:501 S SHORE CTR W
Mailing Address - Street 2:SUITE 103B
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-5762
Mailing Address - Country:US
Mailing Address - Phone:510-521-6510
Mailing Address - Fax:510-521-1465
Practice Address - Street 1:501 S SHORE CTR W
Practice Address - Street 2:SUITE 103B
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-5762
Practice Address - Country:US
Practice Address - Phone:510-521-6510
Practice Address - Fax:510-521-1465
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA00G342310207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G342310Medicaid
1093010001OtherCIGNA MEDICARE DMERC
756181821OtherRR M CARE
A45836Medicare UPIN
CA00G342310Medicaid