Organization
RUSSELL S GORNICHEC MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIM GORNICHEC (OFFICE MANAGER)
(405) 713-4450
Entity
Organization
Contact information
Practice address
3433 NW 56TH ST, SUITE 970, OKLAHOMA CITY, OK 73112-4455
(405) 713-4450
(405) 713-4449
Mailing address
3433 NW 56TH ST, SUITE 970, OKLAHOMA CITY, OK 73112-4455
(405) 713-4450
(405) 713-4449
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00013588
RAILROAD MEDICARE
OK
Enumeration date
07/23/2009
Last updated
12/03/2010
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