Provider Demographics
NPI:1891709226
Name:GOSAIN, SUDHIR
Entity Type:Individual
Prefix:
First Name:SUDHIR
Middle Name:
Last Name:GOSAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25101 DETROIT RD STE 450
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2584
Mailing Address - Country:US
Mailing Address - Phone:440-899-7641
Mailing Address - Fax:440-899-7931
Practice Address - Street 1:25101 DETROIT RD STE 450
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2584
Practice Address - Country:US
Practice Address - Phone:440-899-7641
Practice Address - Fax:440-899-7931
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35066798174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0972907Medicaid
OH0762266Medicare ID - Type Unspecified
OH0972907Medicaid
OH6757300001Medicare NSC