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NPI Code Detail

MEDICARE: DR. ERIC GAUSCHE M.D.

MEDICARE: DR. ERIC GAUSCHE 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
12084B0040XBehavioral Neurology & Neuropsychiatry Physician036124089IL
22084P0800XPsychiatry Physician036124089IL

General Provider Information

NPI Number : 1376733295
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ERIC GAUSCHE M.D.
Provider Business Mailing Address
First Line : 680 N. LAKE SHORE DRIVE
Second Line : SUITE #1000
City : CHICAGO
State : IL
Zip : 60611-8709
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 680 N. LAKE SHORE DRIVE
Second Line : SUITE #1000
City : CHICAGO
State : IL
Zip : 60611-8709
Country : US
Telephone Number : 312-695-0665
Fax Number : 312-695-0050
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2007
Last Update Date : 02/23/2016

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Directions to “ DR. ERIC GAUSCHE M.D.” Practice Location

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