Provider Demographics
NPI:1982284303
Name:GORSKI, MICHAEL KENNETH (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:KENNETH
Last Name:GORSKI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 SUSQUEHANNOCK DR
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-2744
Mailing Address - Country:US
Mailing Address - Phone:570-654-5279
Mailing Address - Fax:
Practice Address - Street 1:296 SUSQUEHANNOCK DR
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-2744
Practice Address - Country:US
Practice Address - Phone:570-654-5279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA062361363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical