Provider Demographics
NPI:1295729366
Name:GAHL, ROBERT A (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:GAHL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7210
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:1516 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:TWO RIVERS
Practice Address - State:WI
Practice Address - Zip Code:54241-3045
Practice Address - Country:US
Practice Address - Phone:920-793-4573
Practice Address - Fax:920-793-4575
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2023-01-30
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Provider Licenses
StateLicense IDTaxonomies
WI23765-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30390200Medicaid
WI30390200Medicaid
WIB84862Medicare UPIN