MEDICARE: KIM J GEHLE 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	208000000X	Pediatrics Physician	036147489	IL

General Provider Information

NPI Number	:	1760400592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM J GEHLE MD

Provider Business Mailing Address
First Line	:	2001 N GARY AVE STE 100
Second Line	:
City	:	WHEATON
State	:	IL
Zip	:	60187-3055
Country	:	US
Telephone Number	:	630-653-5115
Fax Number	:	630-653-4493

Provider Business Practice Location Address
First Line	:	2001 N GARY AVE STE 100
Second Line	:
City	:	WHEATON
State	:	IL
Zip	:	60187-3055
Country	:	US
Telephone Number	:	630-653-5115
Fax Number	:	630-653-4493

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	10/02/2018

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