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General NPI Number Information
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NPI Number | 1316274665
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Entity Type | Organization
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Legal Business Name | MICHAEL J. GEHRKE M.D.
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Dates
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Enumeration Date | 11/06/2009
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Last Update Date | 11/06/2009
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Provider Practice Location Address
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Address Line | 15 S WEBER ST STE B
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-1920
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Country | US
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Telephone | 719-448-0981
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Fax | 719-448-0767
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Provider Business Mailing Address
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Address Line | 15 S WEBER ST STE B
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-1920
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Country | US
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Telephone | 719-448-0981
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Fax | 719-448-0767
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL J GEHRKE
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Credential | M.D.
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Telephone | 719-448-0981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 41056
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License Number State | CO
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