Provider Demographics
NPI:1487667549
Name:GERNDT, STEVEN J (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:GERNDT
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 1:720 S WEBSTER AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-3538
Mailing Address - Country:US
Mailing Address - Phone:920-433-9621
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:720 S WEBSTER AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3538
Practice Address - Country:US
Practice Address - Phone:920-433-9621
Practice Address - Fax:920-445-7289
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI38744208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32314300Medicaid
770002360OtherRAILROAD MEDICARE
F86690Medicare UPIN
WI32314300Medicaid
WI000307690Medicare ID - Type Unspecified