Basic Information
| Provider Information | |||||||||
| NPI: | 1851387302 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOSLING | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | R | ||||||||
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| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3950 HOLLYWOOD RD | ||||||||
| Address2: | SUITE 270 | ||||||||
| City: | SAINT JOSEPH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490859159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2699830500 | ||||||||
| FaxNumber: | 2694292240 | ||||||||
| Practice Location | |||||||||
| Address1: | 3950 HOLLYWOOD RD | ||||||||
| Address2: | SUITE 270 | ||||||||
| City: | SAINT JOSEPH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490859159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2699830500 | ||||||||
| FaxNumber: | 2694292240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2005 | ||||||||
| LastUpdateDate: | 02/09/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301047357 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | A78226 | 01 | HAP | OTHER | 19080 | 01 | HPM | OTHER | 4613113 | 01 | AETNA | OTHER | 04827 | 01 | PARAMOUNT | OTHER | 1851387302 | 05 | MI | MEDICAID | 000000376429 | 01 | ANTHEM | OTHER | 143555 | 01 | GLHP | OTHER | P00255318 | 01 | RRMC | OTHER | 101920 | 01 | CARECHOICE/PREFERRED CHOI | OTHER | 1109403311 | 01 | MI | BCBS | OTHER |