Provider Demographics
NPI:1285792754
Name:GERSTLE, ROGER K (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:K
Last Name:GERSTLE
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 1:1719 S GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-4337
Mailing Address - Country:US
Mailing Address - Phone:231-935-0799
Mailing Address - Fax:231-935-0962
Practice Address - Street 1:1719 S GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-4337
Practice Address - Country:US
Practice Address - Phone:231-935-0799
Practice Address - Fax:231-935-0962
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056940207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0802825942OtherBCBSM PIN NUMBER
MI3308232Medicaid
MIP85174OtherBLUE CARE NETWORK
MITAXID101OtherCOMM. CHOICE MICHIGAN
MI101862OtherPREFERRED CHOICES
MI110124848OtherRAILROAD MEDICARE
MITAXID101OtherCOMM. CHOICE MICHIGAN
MIF71179Medicare UPIN