Provider Demographics
NPI:1043023690
Name:GONSIOROWSKI, ERIC ANTHONY
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:ANTHONY
Last Name:GONSIOROWSKI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5916 WILDROSE LN
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-3547
Mailing Address - Country:US
Mailing Address - Phone:219-781-0318
Mailing Address - Fax:
Practice Address - Street 1:3400 BROADWAY
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46408-1101
Practice Address - Country:US
Practice Address - Phone:888-968-7486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program