Provider Demographics
NPI:1154504017
Name:GERSHTENSON, PLATINA COY (MD)
Entity Type:Individual
Prefix:DR
First Name:PLATINA
Middle Name:COY
Last Name:GERSHTENSON
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 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9010
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:9020 76TH ST STE E
Practice Address - Street 2:
Practice Address - City:PLEASANT PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53158-1976
Practice Address - Country:US
Practice Address - Phone:262-697-8030
Practice Address - Fax:262-697-6157
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125049062207N00000X
WI53248-020207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1154504017Medicaid
WI322500119Medicare PIN