Healthcare Provider Details

I. General information

NPI: 1306930540
Provider Name (Legal Business Name): MICHAEL R GEBAUER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3191 E SEMORAN BLVD
APOPKA FL
32703-5943
US

IV. Provider business mailing address

917 RINEHART RD STE 1051
LAKE MARY FL
32746-4853
US

V. Phone/Fax

Practice location:
  • Phone: 407-788-6500
  • Fax: 407-869-9400
Mailing address:
  • Phone: 407-788-6500
  • Fax: 407-869-9400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0026923
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: