MEDICARE: DR. RICHARD FRANCIS GAEKE MD FACP

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
1	207RG0100X	Gastroenterology Physician	35037374G	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9932791	OTHER	OH	MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000000015648	OTHER	ANTHEM
5	641304	OTHER	AETNA

General Provider Information

NPI Number	:	1174537682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD FRANCIS GAEKE MD FACP

Provider Business Mailing Address
First Line	:	42 NORTH BREIEL BLVD
Second Line	:
City	:	MIDDLETOWN
State	:	OH
Zip	:	45042-3804
Country	:	US
Telephone Number	:	513-422-0024
Fax Number	:	513-422-0232

Provider Business Practice Location Address
First Line	:	42 NORTH BREIEL BLVD
Second Line	:
City	:	MIDDLETOWN
State	:	OH
Zip	:	45042-3804
Country	:	US
Telephone Number	:	513-422-0024
Fax Number	:	513-422-0232

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	12/31/2015

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