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NPI Code Detail

MEDICARE: DR. GARY D KRESGE D.O.

MEDICARE: DR. GARY D KRESGE D.O.
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
1207X00000XOrthopaedic Surgery Physician34-004197OH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1200041541OTHEROHMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134155351
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARY D KRESGE D.O.
Provider Business Mailing Address
First Line : 611 FULTON ST G
Second Line :
City : PORT CLINTON
State : OH
Zip : 43452-2008
Country : US
Telephone Number : 419-732-8837
Fax Number : 419-734-6658
Provider Business Practice Location Address
First Line : 611 FULTON ST G
Second Line :
City : PORT CLINTON
State : OH
Zip : 43452-2008
Country : US
Telephone Number : 419-732-8837
Fax Number : 419-734-6658
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2006
Last Update Date : 11/13/2015

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Directions to “ DR. GARY D KRESGE D.O.” Practice Location

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