Provider Demographics
NPI:1821141250
Name:GOOTZEIT, SHOLOM (DO)
Entity Type:Individual
Prefix:DR
First Name:SHOLOM
Middle Name:
Last Name:GOOTZEIT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13757 W BELL RD
Mailing Address - Street 2:STE 101
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2452
Mailing Address - Country:US
Mailing Address - Phone:623-214-7600
Mailing Address - Fax:623-214-7600
Practice Address - Street 1:17233 N HOLMES BLVD STE 1640
Practice Address - Street 2:13761 W. BELL ROAD, SUITE 203, SURPRISE, AZ 85374
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-2020
Practice Address - Country:US
Practice Address - Phone:602-467-8682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0054632081S0010X, 2081N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular Medicine