Provider Demographics
NPI:1043751225
Name:GAUSVIK, CHRISTIAN ERIK JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:ERIK
Last Name:GAUSVIK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 EDWARDS RD STE 350
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-1940
Mailing Address - Country:US
Mailing Address - Phone:513-871-7848
Mailing Address - Fax:513-871-3278
Practice Address - Street 1:2123 AUBURN AVE
Practice Address - Street 2:SUITE 340
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219
Practice Address - Country:US
Practice Address - Phone:513-585-3238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.029297207Q00000X
OH35.135406207Q00000X, 207QG0300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0444829Medicaid