MEDICARE: DR. ROBERT A GAHL M.D.

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	23765-020	WI

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

General Provider Information

NPI Number	:	1295729366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT A GAHL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 22487
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54305-2487
Country	:	US
Telephone Number	:	920-445-7210
Fax Number	:	920-445-7289

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	01/30/2023

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