Provider Demographics
NPI:1083658181
Name:GERTEN, KIMBERLY ANNE (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANNE
Last Name:GERTEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 FRANCE AVE S STE 200
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2141
Mailing Address - Country:US
Mailing Address - Phone:952-920-2200
Mailing Address - Fax:952-920-0866
Practice Address - Street 1:6565 FRANCE AVE S STE 200
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2141
Practice Address - Country:US
Practice Address - Phone:952-920-2200
Practice Address - Fax:952-920-0866
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN50643207V00000X, 207VG0400X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009931832Medicaid
AL051529678OtherBLUE CROSS
AL051529681OtherBLUE CROSS
AL051529675OtherBLUE CROSS
AL009931831Medicaid
AL009931828Medicaid
AL009931829Medicaid
AL051529676OtherBLUE CROSS
AL051529677OtherBLUE CROSS
AL528200140Medicaid