Individual
THEODORE JOHN GOZDZIALSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
5062 IRONSIDE DR, WATERFORD, MI 48329-1637
(248) 623-2615
Mailing address
5062 IRONSIDE DR, WATERFORD, MI 48329-1637
(248) 623-2615
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
4704106174
MI
Other
Enumeration date
05/04/2009
Last updated
05/04/2009
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