Individual
MILA G GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4065 CENTER RD STE 216, BRUNSWICK, OH 44212-5325
(330) 558-0070
Mailing address
PO BOX 74881, CLEVELAND, OH 44194-0964
(440) 816-6428
(440) 816-6438
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35-038475
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000201811
ANTHEM
OH
01
—
000400732
AETNA
OH
01
—
0100568
UNITED HEALTH CARE
OH
05
—
0367508
—
OH
01
—
080137208
RAILROAD MEDICARE PIN
OH
01
—
341652755006
TRICARE
OH
01
—
84133
QUAL CHOICE
OH
01
—
CG4360
RAILROAD MEDICARE GROUP
OH
Enumeration date
12/29/2005
Last updated
01/06/2011
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