Provider Demographics
NPI:1558698316
Name:DONALD E GEHRIG, MD, INTERNAL MEDICINE, LLC
Entity Type:Organization
Organization Name:DONALD E GEHRIG, MD, INTERNAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:GEHRIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:651-644-5610
Mailing Address - Street 1:393 DUNLAP ST N
Mailing Address - Street 2:SUITE 834
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-4200
Mailing Address - Country:US
Mailing Address - Phone:651-644-5610
Mailing Address - Fax:651-644-1039
Practice Address - Street 1:393 DUNLAP ST N
Practice Address - Street 2:SUITE 834
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4200
Practice Address - Country:US
Practice Address - Phone:651-644-5610
Practice Address - Fax:651-644-1039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-14
Last Update Date:2009-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN25153261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN799002200Medicaid
MN110006081Medicare PIN
MN799002200Medicaid