Basic Information
| Provider Information | |||||||||
| NPI: | 1174839401 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEREDIA MELERO | ||||||||
| FirstName: | GERARDO | ||||||||
| MiddleName: | MANUEL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 E MAXWELL ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405082678 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | UK OBGYN | ||||||||
| Address2: | 125 E. MAXWELL STREET | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593230005 | ||||||||
| FaxNumber: | 8593230790 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2010 | ||||||||
| LastUpdateDate: | 06/10/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VF0040X | 50803 | KY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Female Pelvic Medicine and Reconstructive Surgery |
ID Information
| ID | Type | State | Issuer | Description | 7100488350 | 05 | KY | MEDICAID |