Provider Demographics
NPI:1124058847
Name:SPOELHOF, GERARD DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:GERARD
Middle Name:DAVID
Last Name:SPOELHOF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4190 LOBERG AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-2652
Mailing Address - Country:US
Mailing Address - Phone:218-249-5700
Mailing Address - Fax:218-249-4666
Practice Address - Street 1:4190 LOBERG AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-2652
Practice Address - Country:US
Practice Address - Phone:218-249-5700
Practice Address - Fax:218-249-4666
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42277-020207Q00000X
MN25513207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN345003100Medicaid
MN345003100Medicaid
MND80260Medicare UPIN