Healthcare Provider Details

I. General information

NPI: 1336142207
Provider Name (Legal Business Name): MICHAEL GERBER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 WALES AVE NW STE C
MASSILLON OH
44646-2366
US

IV. Provider business mailing address

2400 WALES AVE NW STE C
MASSILLON OH
44646-2366
US

V. Phone/Fax

Practice location:
  • Phone: 330-880-0088
  • Fax: 330-880-0089
Mailing address:
  • Phone: 330-880-0088
  • Fax: 330-880-0089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36002652
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: