MEDICARE: ROBERT A. GAHL, M.D., FAAFP, S.C.

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

General Provider Information

NPI Number	:	1265423792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT A. GAHL, M.D., FAAFP, S.C.

Provider Business Mailing Address
First Line	:	6400 INDUSTRIAL LOOP
Second Line	:
City	:	GREENDALE
State	:	WI
Zip	:	53129-2452
Country	:	US
Telephone Number	:	414-423-4100
Fax Number	:	414-423-4134

Provider Business Practice Location Address
First Line	:	1516 WASHINGTON ST
Second Line	:
City	:	TWO RIVERS
State	:	WI
Zip	:	54241-3045
Country	:	US
Telephone Number	:	920-793-4573
Fax Number	:	920-793-4575

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT A GAHL
Credential	:	M.D.
Telephone Number	:	920-793-4573

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	10/20/2015

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