Healthcare Provider Details

I. General information

NPI: 1114961976
Provider Name (Legal Business Name): ERNEST CHARLES GUMPRECHT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 N SANDUSKY AVE
BUCYRUS OH
44820-1821
US

IV. Provider business mailing address

700 N COLUMBUS ST
CRESTLINE OH
44827-1455
US

V. Phone/Fax

Practice location:
  • Phone: 419-462-4600
  • Fax: 419-462-4609
Mailing address:
  • Phone: 419-462-4600
  • Fax: 419-462-4609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35.132701
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: