Provider Demographics
NPI:1215993407
Name:KADLEC, GARY J (NP)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:J
Last Name:KADLEC
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0001
Mailing Address - Country:US
Mailing Address - Phone:507-284-2511
Mailing Address - Fax:
Practice Address - Street 1:200 1ST ST SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-0001
Practice Address - Country:US
Practice Address - Phone:507-284-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000515363LF0000X
MNR 137351-6363LF0000X
MN2220363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
03M99KAOtherCC SYSTEMS/BLUE PLUS
SD1215993407OtherARAZ/ AMERICA'S PPO
SD57105AV03OtherWPS TRICARE
HP30848OtherHEALTHPARTNERS
SD1215993407OtherMEDICA
MN826633600Medicaid
SD9254228OtherDAKOTACARE
C70831024659OtherPREFERRED ONE
MN03M99KAOtherBLUE PLUS
MNP01100002OtherMEDICARE RAILROAD
SD4992605OtherBLUE CROSS
IA1417921685Medicaid
SD6829970Medicaid
SD57105AV03OtherWPS TRICARE
SD1215993407OtherARAZ/ AMERICA'S PPO