Individual
MICHAEL DEAN GOSTOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
18 KENNY DR, YAKIMA, WA 98902-2712
(509) 952-2447
Mailing address
PO BOX 354, BUENA, WA 98921-0354
(509) 865-6705
(509) 865-5011
Taxonomy
Speciality
Code
Description
License number
State
171WH0202X
Home Modifications Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GOSTOMD355N2
WADL
WA
Enumeration date
11/02/2018
Last updated
11/02/2018
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