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NPI Code Detail

MEDICARE: DR. GAYLE M KASDORF M.D.

MEDICARE: DR. GAYLE M KASDORF 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
1207RE0101XEndocrinology, Diabetes & Metabolism Physician24544WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629071485
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GAYLE M KASDORF M.D.
Provider Business Mailing Address
First Line : 704 S WEBSTER AVE
Second Line : STE 500
City : GREEN BAY
State : WI
Zip : 54301-3528
Country : US
Telephone Number : 920-468-9588
Fax Number : 920-468-1342
Provider Business Practice Location Address
First Line : 1715 DOUSMAN ST
Second Line :
City : GREEN BAY
State : WI
Zip : 54303-3211
Country : US
Telephone Number : 920-496-4700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 09/05/2019

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