Provider Demographics
NPI:1144262916
Name:DOUGLAS C GULA DO PA, MIDWEST ORTHOPEDICS AND SPORTS MEDICINE
Entity type:Organization
Organization Name:DOUGLAS C GULA DO PA, MIDWEST ORTHOPEDICS AND SPORTS MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:GULA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:513-523-4290
Mailing Address - Street 1:PO BOX 643623
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-0308
Mailing Address - Country:US
Mailing Address - Phone:513-524-4290
Mailing Address - Fax:513-523-0767
Practice Address - Street 1:5144B COLLEGE CORNER PIKE
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056
Practice Address - Country:US
Practice Address - Phone:513-524-4290
Practice Address - Fax:513-523-0767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003360G207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2293496Medicaid
OHCH8796OtherRR MEDICARE
OHCH8796OtherRR MEDICARE
OH=========00OtherWORK COMP
IN194240Medicare UPIN