Provider Demographics
NPI:1629029426
Name:GOSAIN, ARUN (MD)
Entity Type:Individual
Prefix:DR
First Name:ARUN
Middle Name:
Last Name:GOSAIN
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 1:225 E CHICAGO AVE # 63
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2991
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:225 E CHICAGO AVE # 63
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:800-543-7362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361305532086S0122X
OH35-0886002086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000503658OtherANTHEM
002000117UOtherHUMANA
OH2687025OtherBCMH
OH2687025Medicaid
WI31604200Medicaid
PA1022537400001Medicaid
OH363574OtherWELLCARE MEDICAID
OH4610200OtherAETNA
OH000000216484OtherUNISON
MI1629029426OtherMICHIGAN MEDICAID
OH750613OtherBUCKEYE MEDICAID
OH2687025OtherBCMH
OH363574OtherWELLCARE MEDICAID
OHGO4194462Medicare PIN