Provider Demographics
NPI:1861425472
Name:BEXELL-GIERKE, JAN M (MD)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:M
Last Name:BEXELL-GIERKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAN
Other - Middle Name:M
Other - Last Name:BEXELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-3300
Mailing Address - Fax:701-364-8906
Practice Address - Street 1:3000 32ND AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6132
Practice Address - Country:US
Practice Address - Phone:701-364-8000
Practice Address - Fax:701-364-8078
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND10079207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND13564Medicaid
NDDA9011045196OtherPREFERRED ONE #
ND25937OtherNDBS #
MN467419700Medicaid
ND2377932OtherAMERICA'S PPO/ARAZ #
NDHP56024OtherHEALTHPARTNERS #
ND0704493OtherMEDICA #
ND012H2BEOtherMNBS #
NDF87497Medicare UPIN
NDHP56024OtherHEALTHPARTNERS #
NDDA9011045196OtherPREFERRED ONE #