Provider Demographics
NPI:1417908948
Name:GEHL, SUZANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:
Last Name:GEHL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 N JENKINS DR
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-8721
Mailing Address - Country:US
Mailing Address - Phone:414-520-4900
Mailing Address - Fax:855-457-4343
Practice Address - Street 1:1023 W STATE ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:WI
Practice Address - Zip Code:53027-2726
Practice Address - Country:US
Practice Address - Phone:262-444-0124
Practice Address - Fax:855-457-4343
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28521207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31497600Medicaid
WI31497600Medicaid
E70979Medicare UPIN
E70979Medicare UPIN