Provider Demographics
NPI:1437168101
Name:GEMLO, BRETT (MD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:
Last Name:GEMLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3433 BROADWAY ST NE STE 115
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1759
Mailing Address - Country:US
Mailing Address - Phone:651-312-1500
Mailing Address - Fax:651-312-1570
Practice Address - Street 1:1983 SLOAN PL
Practice Address - Street 2:# 11
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117-2087
Practice Address - Country:US
Practice Address - Phone:651-312-1620
Practice Address - Fax:651-312-1570
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN33764208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN518707900Medicaid
MN518707900Medicaid