Provider Demographics
NPI:1700922838
Name:GEHRKE, MICHAEL JUSTIN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JUSTIN
Last Name:GEHRKE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2120 FOWLER ST STE 600
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-3928
Mailing Address - Country:US
Mailing Address - Phone:197-659-7168
Mailing Address - Fax:719-269-8024
Practice Address - Street 1:333 W HAMPDEN AVE
Practice Address - Street 2:SUITE #600
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-2330
Practice Address - Country:US
Practice Address - Phone:303-761-5646
Practice Address - Fax:303-761-9280
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2024-10-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN65998207L00000X
WI77830-20207L00000X
CO41056207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO37838334Medicaid
COC809472Medicare PIN