Healthcare Provider Details

I. General information

NPI: 1700922838
Provider Name (Legal Business Name): MICHAEL JUSTIN GEHRKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W HAMPDEN AVE SUITE #600
ENGLEWOOD CO
80110-2330
US

IV. Provider business mailing address

2120 FOWLER ST STE 600
CANON CITY CO
81212-3928
US

V. Phone/Fax

Practice location:
  • Phone: 303-761-5646
  • Fax: 303-761-9280
Mailing address:
  • Phone: 197-659-7168
  • Fax: 719-269-8024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number65998
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number77830-20
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number41056
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: