Healthcare Provider Details

I. General information

NPI: 1962405654
Provider Name (Legal Business Name): DAN L GEHLBACH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20375 W 151ST ST STE 403
OLATHE KS
66061-7209
US

IV. Provider business mailing address

10539 S CHESNEY LN
OLATHE KS
66061-2775
US

V. Phone/Fax

Practice location:
  • Phone: 913-780-4300
  • Fax: 913-780-4250
Mailing address:
  • Phone: 913-393-1519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number04-20706
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: