Provider Demographics
NPI:1467537985
Name:GUREASKO, MICHAEL ALLAN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALLAN
Last Name:GUREASKO
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 1:2123 AUBURN AVE
Mailing Address - Street 2:306
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219
Mailing Address - Country:US
Mailing Address - Phone:513-281-8840
Mailing Address - Fax:513-281-5314
Practice Address - Street 1:2123 AUBURN AVE
Practice Address - Street 2:306
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219
Practice Address - Country:US
Practice Address - Phone:513-281-8840
Practice Address - Fax:513-281-5314
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH350324412084A0401X, 2084P0804X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0270326Medicaid
C01086Medicare UPIN
OH0270326Medicaid