Provider Demographics
NPI:1629001144
Name:GORODESKI, GEORGE I (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:I
Last Name:GORODESKI
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 1:25154 BRIDGETON DR
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1710
Mailing Address - Country:US
Mailing Address - Phone:216-831-2751
Mailing Address - Fax:
Practice Address - Street 1:25154 BRIDGETON DR
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-1710
Practice Address - Country:US
Practice Address - Phone:216-831-2751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-057192207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology