Basic Information
| Provider Information | |||||||||
| NPI: | 1083658181 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GERTEN | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6565 FRANCE AVE S STE 200 | ||||||||
| Address2: | |||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554352141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529202200 | ||||||||
| FaxNumber: | 9529200866 | ||||||||
| Practice Location | |||||||||
| Address1: | 6565 FRANCE AVE S STE 200 | ||||||||
| Address2: | |||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554352141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529202200 | ||||||||
| FaxNumber: | 9529200866 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 11/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 50643 | MN | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VG0400X | 50643 | MN | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | 207VF0040X | 50643 | MN | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Female Pelvic Medicine and Reconstructive Surgery |
ID Information
| ID | Type | State | Issuer | Description | 009931832 | 05 | AL | MEDICAID | 051529678 | 01 | AL | BLUE CROSS | OTHER | 051529681 | 01 | AL | BLUE CROSS | OTHER | 051529675 | 01 | AL | BLUE CROSS | OTHER | 009931831 | 05 | AL | MEDICAID | 009931828 | 05 | AL | MEDICAID | 009931829 | 05 | AL | MEDICAID | 051529676 | 01 | AL | BLUE CROSS | OTHER | 051529677 | 01 | AL | BLUE CROSS | OTHER | 528200140 | 05 | AL | MEDICAID |