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NPI Code Detail

MEDICARE: DR. AUSTIN GEPHART DO

MEDICARE: DR. AUSTIN GEPHART DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician036.180297IL

General Provider Information

NPI Number : 1063101103
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AUSTIN GEPHART DO
Provider Business Mailing Address
First Line : 600 S PAULINA ST
Second Line :
City : CHICAGO
State : IL
Zip : 60612-3806
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 600 S PAULINA ST
Second Line :
City : CHICAGO
State : IL
Zip : 60612-3806
Country : US
Telephone Number : 312-942-7100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2023
Last Update Date : 05/20/2026

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