MEDICARE: MR. GERALD E GAVLAK PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9102311	FL

General Provider Information

NPI Number	:	1003929381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GERALD E GAVLAK PA

Provider Business Mailing Address
First Line	:	5001 TRANSPORTATION DR STE 101
Second Line	:
City	:	SHEFFIELD VILLAGE
State	:	OH
Zip	:	44054-2850
Country	:	US
Telephone Number	:	440-329-2800
Fax Number	:	440-329-2810

Provider Business Practice Location Address
First Line	:	5001 TRANSPORTATION DR STE 101
Second Line	:
City	:	SHEFFIELD VILLAGE
State	:	OH
Zip	:	44054-2850
Country	:	US
Telephone Number	:	440-329-2800
Fax Number	:	440-329-2810

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	01/12/2021

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