Provider Demographics
NPI:1912053349
Name:GORALKA, MICHAEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:GORALKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2874 N CARSON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-0177
Mailing Address - Country:US
Mailing Address - Phone:775-883-9003
Mailing Address - Fax:775-883-0959
Practice Address - Street 1:2874 N CARSON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-0177
Practice Address - Country:US
Practice Address - Phone:775-883-9003
Practice Address - Fax:775-883-0959
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8584207RA0000X
WY13288C207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV110238211OtherRAILROAD MEDICARE #
NV002013070Medicaid
NV003113070Medicaid
NVCC2258OtherBCBS PROVIDER #
NV34632Medicare ID - Type Unspecified
NVCC2258OtherBCBS PROVIDER #