MEDICARE: MICHAEL EARL GAMBLE

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	342000000X	Transportation Network Company	343900000X	OH
2	342000000X	Transportation Network Company		OH
3	342000000X	Transportation Network Company
4	342000000X	Transportation Network Company	873328741	OH
5	347E00000X	Transportation Broker
6	3747A0650X	Attendant Care Provider
7	305R00000X	Preferred Provider Organization		OH

General Provider Information

NPI Number	:	1477392710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL EARL GAMBLE

Provider Business Mailing Address
First Line	:	3212 W 97TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-4744
Country	:	US
Telephone Number	:	216-356-9186
Fax Number	:

Provider Business Practice Location Address
First Line	:	3212 W 97TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-4744
Country	:	US
Telephone Number	:	216-356-9186
Fax Number	:

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

Provider Enumeration Date	:	05/24/2024
Last Update Date	:	05/24/2024

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Directions to “ MICHAEL EARL GAMBLE ” Practice Location

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