MEDICARE: DR. ALAN P. GEGENHEIMER D.O.

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	207X00000X	Orthopaedic Surgery Physician	036-099781	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730119561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN P. GEGENHEIMER D.O.

Provider Business Mailing Address
First Line	:	6308 8TH AVE
Second Line	:	ATTN: MEDICAL STAFF OFFICE
City	:	KENOSHA
State	:	WI
Zip	:	53143-5031
Country	:	US
Telephone Number	:	262-656-3313
Fax Number	:	262-653-5850

Provider Business Practice Location Address
First Line	:	9697 SAINT CATHERINES DR
Second Line	:	SUITE 200
City	:	PLEASANT PRAIRIE
State	:	WI
Zip	:	53158-2118
Country	:	US
Telephone Number	:	262-656-3590
Fax Number	:	262-656-3591

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	08/09/2016

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