Provider Demographics
NPI:1841374873
Name:GORSKI, MARIE JANE (MD)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:JANE
Last Name:GORSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5009
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37024-5009
Mailing Address - Country:US
Mailing Address - Phone:615-221-1400
Mailing Address - Fax:931-388-5154
Practice Address - Street 1:3331 W DEYOUNG ST STE 305
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959
Practice Address - Country:US
Practice Address - Phone:618-998-7155
Practice Address - Fax:618-998-7285
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036095265208600000X
TN33917208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3853897Medicaid
020053440OtherMEDICARE RR
G50975Medicare UPIN
TN3853897Medicaid