Provider Demographics
NPI:1316929508
Name:TASCH, GAIL A (MD)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:A
Last Name:TASCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2153 EASTRIDGE CTR
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-3403
Mailing Address - Country:US
Mailing Address - Phone:715-895-8558
Mailing Address - Fax:715-895-8559
Practice Address - Street 1:2153 EASTRIDGE CTR
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-3403
Practice Address - Country:US
Practice Address - Phone:715-895-8558
Practice Address - Fax:715-895-8559
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA327782084P0800X
FLME946342084P0800X
WI270962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013446100Medicaid
WI30660200Medicaid
WI30660200Medicaid
WI000020013Medicare ID - Type Unspecified