MEDICARE: DAVID M GAST MD

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	208100000X	Physical Medicine & Rehabilitation Physician	4301051117	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0690010	OTHER	MI	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518953934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID M GAST MD

Provider Business Mailing Address
First Line	:	1500 SANDPOINT RD
Second Line	:
City	:	MUNISING
State	:	MI
Zip	:	49862-1406
Country	:	US
Telephone Number	:	906-387-4338
Fax Number	:	906-387-2825

Provider Business Practice Location Address
First Line	:	15 GRACELAWN RD
Second Line	:
City	:	AUBURN
State	:	ME
Zip	:	04210-6334
Country	:	US
Telephone Number	:	207-333-4799
Fax Number	:	207-333-4767

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

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	05/11/2021

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Directions to “ DAVID M GAST MD” Practice Location

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