Provider Demographics
NPI:1457345126
Name:GEPHART, JEFFREY F (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:F
Last Name:GEPHART
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 1:4602 DEPT
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-0021
Mailing Address - Country:US
Mailing Address - Phone:906-225-7601
Mailing Address - Fax:906-225-7453
Practice Address - Street 1:1414 W FAIR AVE
Practice Address - Street 2:STE 111
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2675
Practice Address - Country:US
Practice Address - Phone:906-225-7601
Practice Address - Fax:906-225-7453
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301038795207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110107125OtherRAILROAD MEDICARE
MIJG038795OtherBCBS OF MICHIGAN
MI3190947Medicaid
MIJG038795OtherBCBSM
MI110107125OtherRAILROAD MEDICARE
MI3190947Medicaid