Basic Information
| Provider Information | |||||||||
| NPI: | 1770793424 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GAEBLER-UHING | ||||||||
| FirstName: | CHARLENE | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GAEBLER | ||||||||
| OtherFirstName: | CHARLIE | ||||||||
| OtherMiddleName: | L. | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3365 S 103RD ST STE 210 | ||||||||
| Address2: | |||||||||
| City: | GREENFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532274108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2628147080 | ||||||||
| FaxNumber: | 2624329004 | ||||||||
| Practice Location | |||||||||
| Address1: | 3365 S 103RD ST STE 210 | ||||||||
| Address2: | |||||||||
| City: | GREENFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532274108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2628147080 | ||||||||
| FaxNumber: | 2624329004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 44220 | WI | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080A0000X | 44220-20 | WI | Y | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine |
ID Information
| ID | Type | State | Issuer | Description | BG3333678 | 01 | WI | DEA NUMBER | OTHER | 34176800 | 05 | WI | MEDICAID | 1770793424 | 05 | WI | MEDICAID |