Healthcare Provider Details

I. General information

NPI: 1376733295
Provider Name (Legal Business Name): ERIC GAUSCHE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 N. LAKE SHORE DRIVE SUITE #1000
CHICAGO IL
60611-8709
US

IV. Provider business mailing address

680 N. LAKE SHORE DRIVE SUITE #1000
CHICAGO IL
60611-8709
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-0665
  • Fax: 312-695-0050
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number036124089
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036124089
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: