Basic Information
| Provider Information | |||||||||
| NPI: | 1134185051 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GERKEN | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4750 HEMPSTEAD STATION DR | ||||||||
| Address2: | |||||||||
| City: | KETTERING | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454295164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008750136 | ||||||||
| FaxNumber: | 9376194231 | ||||||||
| Practice Location | |||||||||
| Address1: | 629 N SANDUSKY AVE | ||||||||
| Address2: | |||||||||
| City: | BUCYRUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448201821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195624677 | ||||||||
| FaxNumber: | 4195620987 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2006 | ||||||||
| LastUpdateDate: | 06/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 4301502408 | MI | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 35082874 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 4301502408 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00205797 | 01 | OH | RR MEDICARE - GREENFIELD | OTHER | P00263123 | 01 | OH | RR MEDICARE FOR BUCYRUS | OTHER | P00143218 | 01 | OH | RR MEDICARE FOR MADISON | OTHER | 000000339750 | 01 | OH | BCBS FOR MADISON | OTHER | 000000384551 | 01 | OH | BCBS FOR GALION | OTHER | 000000346397 | 01 | OH | BCBS FOR GREENFIELD | OTHER | 2466700 | 05 | OH | MEDICAID | P00306579 | 01 | RR | OTHER | 000000362624 | 01 | OH | BCBS FOR BUCYRUS | OTHER | 000000384661 | 01 | BCBS GALION | OTHER |