Basic Information
| Provider Information | |||||||||
| NPI: | 1609094473 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GERLACH | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3922 WOODLEY RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436061130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192912121 | ||||||||
| FaxNumber: | 4194796017 | ||||||||
| Practice Location | |||||||||
| Address1: | 3922 WOODLEY RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436061130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192912121 | ||||||||
| FaxNumber: | 4194796017 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2007 | ||||||||
| LastUpdateDate: | 09/08/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 35.089023 | OH | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 7475901 | 01 | OH | PPOM | OTHER | 47131 | 01 | MI | HEALTH PLAN OF MICHIGAN | OTHER | 2751071 | 05 | OH | MEDICAID | 000000538191 | 01 | OH | ANTHEM | OTHER | 7574901 | 01 | OH | AETNA | OTHER | 06791 | 01 | OH | PARAMOUNT | OTHER |