Basic Information
| Provider Information | |||||||||
| NPI: | 1700922838 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GEHRKE | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | JUSTIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2120 FOWLER ST STE 600 | ||||||||
| Address2: | |||||||||
| City: | CANON CITY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 812123928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1976597168 | ||||||||
| FaxNumber: | 7192698024 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 W HAMPDEN AVE | ||||||||
| Address2: | SUITE #600 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801102330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037615646 | ||||||||
| FaxNumber: | 3037619280 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 09/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 65998 | TN | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 41056 | CO | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 37838334 | 05 | CO | MEDICAID |