Provider Demographics
NPI:1225227135
Name:MICHAEL E GEWE OD PC
Entity Type:Organization
Organization Name:MICHAEL E GEWE OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:GEWE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:618-327-3231
Mailing Address - Street 1:250 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62263-1710
Mailing Address - Country:US
Mailing Address - Phone:618-327-3231
Mailing Address - Fax:618-327-8748
Practice Address - Street 1:250 E ELM ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:IL
Practice Address - Zip Code:62263-1710
Practice Address - Country:US
Practice Address - Phone:618-327-3231
Practice Address - Fax:618-327-8748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046006845152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT92292OtherTPA LICENSE
IL791580519Medicare PIN
IL607230Medicare PIN
ILT92292OtherTPA LICENSE
ILT37204Medicare UPIN