Provider Demographics
NPI:1578663522
Name:CONSULTANTS IN GASTROENTEROLOGY INC
Entity Type:Organization
Organization Name:CONSULTANTS IN GASTROENTEROLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTTESMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-461-2550
Mailing Address - Street 1:5900 LANDERBROOK DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-4020
Mailing Address - Country:US
Mailing Address - Phone:440-461-2550
Mailing Address - Fax:
Practice Address - Street 1:5900 LANDERBROOK DR
Practice Address - Street 2:SUITE 190
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-4020
Practice Address - Country:US
Practice Address - Phone:440-461-2550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0645270Medicaid
OH0645270Medicaid