Individual
BRYAN P GOUGIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3440 171ST PL, HAMMOND, IN 46323-2807
(888) 858-7372
(888) 858-7372
Mailing address
279 MERRILL AVE, CALUMET CITY, IL 60409-1716
(773) 209-1968
(888) 858-7372
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
15-013746-1
IN
376J00000X
Homemaker
Primary
15-013746-1
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201352780A
—
IN
Enumeration date
06/08/2017
Last updated
06/08/2017
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