Basic Information
| Provider Information | |||||||||
| NPI: | 1528064029 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GERSTENMAIER | ||||||||
| FirstName: | LUIS | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3140 W CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436062920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195375111 | ||||||||
| FaxNumber: | 4195375131 | ||||||||
| Practice Location | |||||||||
| Address1: | 3140 W CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436062920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195375111 | ||||||||
| FaxNumber: | 4195375131 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 35036136 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 0234295 | 05 | OH | MEDICAID | 00071 | 01 | OH | PARAMOUNT | OTHER | 000000203476 | 01 | OH | ANTHEM | OTHER | 4002420 | 01 | OH | AETNA | OTHER |