Provider Demographics
NPI:1871640029
Name:GORGA, MICHAEL P (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:GORGA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2136
Mailing Address - Country:US
Mailing Address - Phone:402-280-8100
Mailing Address - Fax:402-280-8103
Practice Address - Street 1:555 N 30TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2136
Practice Address - Country:US
Practice Address - Phone:402-498-6540
Practice Address - Fax:402-498-6357
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE56231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1588251Medicaid
IA2588244Medicaid
IA0588244Medicaid
IA2588251Medicaid
IA4588244Medicaid
IA6588244Medicaid
IA3588244Medicaid
IA8588244Medicaid
IA3588251Medicaid
NE36811OtherBCBS ENT
IA7588244Medicaid
NE36824OtherBCBS BT
IA9588244Medicaid
IA1058251Medicaid
IA1588244Medicaid
NE640004738Medicare ID - Type UnspecifiedRR
IA6588244Medicaid
IA0588244Medicaid