Provider Demographics
NPI:1568441863
Name:GERNDT, JULIE S (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:S
Last Name:GERNDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8674
Mailing Address - Street 2:MANKATO CLINIC LTD
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56002-8674
Mailing Address - Country:US
Mailing Address - Phone:507-625-1811
Mailing Address - Fax:
Practice Address - Street 1:MADISON EAST CENTER
Practice Address - Street 2:STE 352 MANKATO CLINIC DEPARTMENT OF PSYCHIATRY
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001
Practice Address - Country:US
Practice Address - Phone:507-387-3195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN307672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
260050340OtherRR MEDICARE
410849339 56001 C024OtherCHAMPUS
MN939785000Medicaid
MNHP36767OtherHEALTH PARTNERS
MNNA2951015938OtherPREFERRED ONE
IA0572164Medicaid
MN116333OtherU CARE
MN388R9GEOtherBC BS
MN771664OtherAMERICAS PPO
260050340OtherRR MEDICARE
IA0572164Medicaid