Provider Demographics
NPI:1992735336
Name:FERNANDEZ GATTI, EMILIO CARLOS (MD)
Entity type:Individual
Prefix:
First Name:EMILIO
Middle Name:CARLOS
Last Name:FERNANDEZ GATTI
Suffix:
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 1:2700 W 9TH AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-7247
Mailing Address - Country:US
Mailing Address - Phone:920-223-2727
Mailing Address - Fax:
Practice Address - Street 1:2700 W 9TH AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-7247
Practice Address - Country:US
Practice Address - Phone:920-223-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2009-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010464702084N0400X
WI527922084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1992735336Medicaid
MI1306910311OtherBCBSM PROVIDER NUMBER
WI453000614Medicare PIN
MI4700034Medicare ID - Type UnspecifiedPROVIDER NUMBER
MI1306910311OtherBCBSM PROVIDER NUMBER
0F96004020Medicare ID - Type UnspecifiedPROVIDER NUMBER
C44917Medicare UPIN