MEDICARE: ANDREW J. GASE, M.D., INC

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	207Q00000X	Family Medicine Physician	35-053787	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1245296474
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDREW J. GASE, M.D., INC

Provider Business Mailing Address
First Line	:	27 ST. LAWRENCE DR
Second Line	:	SUITE 101
City	:	TIFFIN
State	:	OH
Zip	:	44883-8313
Country	:	US
Telephone Number	:	419-447-4214
Fax Number	:

Provider Business Practice Location Address
First Line	:	27 ST. LAWRENCE DR
Second Line	:	SUITE 101
City	:	TIFFIN
State	:	OH
Zip	:	44883-8313
Country	:	US
Telephone Number	:	419-447-4214
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MRS. ANNE H GASE
Credential	:
Telephone Number	:	419-447-4214

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	06/08/2012

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