Provider Demographics
NPI:1023280211
Name:JOSEPH A. GOLISH, MD, INC.
Entity type:Organization
Organization Name:JOSEPH A. GOLISH, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOLISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-918-7712
Mailing Address - Street 1:28099 SHAKER BLVD
Mailing Address - Street 2:
Mailing Address - City:PEPPER PIKE
Mailing Address - State:OH
Mailing Address - Zip Code:44124-5003
Mailing Address - Country:US
Mailing Address - Phone:440-918-7712
Mailing Address - Fax:440-918-7714
Practice Address - Street 1:7676 REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5127
Practice Address - Country:US
Practice Address - Phone:440-918-7712
Practice Address - Fax:440-918-7714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-038013174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0290911Medicaid
C01233Medicare UPIN