Healthcare Provider Details

I. General information

NPI: 1427826122
Provider Name (Legal Business Name): GABRIEL LOUIS OPSAHL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 MADISON AVE
TOLEDO OH
43604-7132
US

IV. Provider business mailing address

2221 MADISON AVE
TOLEDO OH
43604-7132
US

V. Phone/Fax

Practice location:
  • Phone: 419-251-1313
  • Fax:
Mailing address:
  • Phone: 419-251-1313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0010342
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: