MEDICARE: GACEK EAR AND SINUS CENTER LLC

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	207Y00000X	Otolaryngology Physician	0002170	AL

Other Identifiers

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

General Provider Information

NPI Number	:	1932449451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GACEK EAR AND SINUS CENTER LLC

Provider Business Mailing Address
First Line	:	4721 MORRISON DR STE 400
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36609-3350
Country	:	US
Telephone Number	:	251-340-6947
Fax Number	:	251-460-5457

Provider Business Practice Location Address
First Line	:	720 HILLCREST RD STE A
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36695-3904
Country	:	US
Telephone Number	:	251-340-7970
Fax Number	:	251-340-7971

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. MARK R GACEK
Credential	:	M.D.
Telephone Number	:	251-340-7970

Provider Enumeration Date	:	02/20/2013
Last Update Date	:	08/24/2022

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