MEDICARE: PATRICK GEHRLICH PLLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1730822941
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATRICK GEHRLICH PLLC

Provider Business Mailing Address
First Line	:	4007 N BROADWAY ST STE 209
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-6076
Country	:	US
Telephone Number	:	513-593-0663
Fax Number	:	773-439-5683

Provider Business Practice Location Address
First Line	:	4007 N BROADWAY ST STE 209
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-6076
Country	:	US
Telephone Number	:	513-593-0663
Fax Number	:	773-439-5683

Authorized Official
Title or Position	:	CEO
Name	:	PATRICK GEHRLICH
Credential	:	LCSW
Telephone Number	:	513-593-0663

Provider Enumeration Date	:	04/15/2022
Last Update Date	:	04/15/2022

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