Basic Information
| Provider Information | |||||||||
| NPI: | 1437168101 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GEMLO | ||||||||
| FirstName: | BRETT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3433 BROADWAY ST NE STE 115 | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554131759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6513121500 | ||||||||
| FaxNumber: | 6513121570 | ||||||||
| Practice Location | |||||||||
| Address1: | 1983 SLOAN PL | ||||||||
| Address2: | # 11 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551172087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6513121620 | ||||||||
| FaxNumber: | 6513121570 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 02/26/2018 | ||||||||
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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 | 208C00000X | 33764 | MN | Y | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery |
ID Information
| ID | Type | State | Issuer | Description | 518707900 | 05 | MN | MEDICAID |