Basic Information
| Provider Information | |||||||||
| NPI: | 1285797704 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GEHLBACH | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | KENT | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GEHLBACH | ||||||||
| OtherFirstName: | BRIAN | ||||||||
| OtherMiddleName: | K | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 200 HAWKINS DRIVE C33-GH UNIVERSITY OF IOWA HEALTH CARE | ||||||||
| Address2: | DIVISION OF PULMONARY, CRITICAL CARE, & OCCUPATIONAL ME | ||||||||
| City: | IOWA CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 52242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193563603 | ||||||||
| FaxNumber: | 3193536406 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 HAWKINS DRIVE C33-GH UNIVERSITY OF IOWA HEALTH CARE | ||||||||
| Address2: | DIVISION OF PULMONARY, CRITICAL CARE, & OCCUPATIONAL ME | ||||||||
| City: | IOWA CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 52242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193563603 | ||||||||
| FaxNumber: | 3193536406 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2006 | ||||||||
| LastUpdateDate: | 09/09/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 39594 | IA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207R00000X | 39594 | IA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RP1001X | 036097202 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RP1001X | 39594 | IA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 036097202 | 05 | IL | MEDICAID |