Provider Demographics
NPI:1245231158
Name:GERWICK, CHARLES L (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:L
Last Name:GERWICK
Suffix:
Gender:M
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:PO BOX 411039
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-1039
Mailing Address - Country:US
Mailing Address - Phone:913-234-1350
Mailing Address - Fax:
Practice Address - Street 1:12300 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1324
Practice Address - Country:US
Practice Address - Phone:913-317-7485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-21036207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100125130CMedicaid
KS16821061OtherBCBS KC MO
930036540OtherRR MEDICARE GROUP CG8899
KS100125130AMedicaid
KS01674018OtherBCBS KC MO GROUP 01674018
P00194091OtherRR MEDICARE GROUP DC6712
MO16821081OtherBCBS OF KC MO
MO206039901Medicaid
KS7635744Medicare PIN
KS01674018OtherBCBS KC MO GROUP 01674018
MO206039901Medicaid