Provider Demographics
NPI:1629035076
Name:GOZIA, PENNY SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:PENNY
Middle Name:SUE
Last Name:GOZIA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:9447 HOLY CROSS LN
Mailing Address - Street 2:
Mailing Address - City:BREESE
Mailing Address - State:IL
Mailing Address - Zip Code:62230-3510
Mailing Address - Country:US
Mailing Address - Phone:618-526-2209
Mailing Address - Fax:618-526-7372
Practice Address - Street 1:9447 HOLY CROSS LN
Practice Address - Street 2:
Practice Address - City:BREESE
Practice Address - State:IL
Practice Address - Zip Code:62230-3510
Practice Address - Country:US
Practice Address - Phone:618-526-2209
Practice Address - Fax:618-526-7372
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2011-05-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036063583207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C46091Medicare UPIN