Basic Information
| Provider Information | |||||||||
| NPI: | 1265429542 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOBELDYK | ||||||||
| FirstName: | GERARD | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16472 LAUREL RD | ||||||||
| Address2: | |||||||||
| City: | ST JOSEPH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202525131 | ||||||||
| FaxNumber: | 3202402118 | ||||||||
| Practice Location | |||||||||
| Address1: | 16472 LAUREL RD | ||||||||
| Address2: | |||||||||
| City: | ST JOSEPH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202525131 | ||||||||
| FaxNumber: | 3202402118 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2005 | ||||||||
| LastUpdateDate: | 09/14/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 26110 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 6D057BO | 01 | BLUE CROSS BLUE SHIELD | OTHER | 110104504 | 01 | RR MEDICARE | OTHER | 986003 | 01 | PREFERRED ONE | OTHER | HP22731 | 01 | HEALTH PARTNERS | OTHER | 600903 | 01 | ARAZ GROUP/AMERICAS PPO | OTHER | 2114072 | 01 | FIRST HEALTH PLAN | OTHER | 0400499 | 01 | MEDICA HEALTH PLANS | OTHER | 110893 | 01 | U-CARE | OTHER | 037802000 | 01 | MEDICAL ASSISTANCE (MA) | OTHER |