Provider Demographics
NPI:1649239708
Name:NATZKE, GERALD DEAN JR (DO)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:DEAN
Last Name:NATZKE
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2284 S BALLENGER HWY
Mailing Address - Street 2:SUITE H
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-4653
Mailing Address - Country:US
Mailing Address - Phone:810-233-5211
Mailing Address - Fax:810-233-5740
Practice Address - Street 1:2284 S BALLENGER HWY
Practice Address - Street 2:SUITE H
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-4653
Practice Address - Country:US
Practice Address - Phone:810-233-5211
Practice Address - Fax:810-233-5740
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGN008130208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5250046OtherBCBS
MI3048803Medicaid
0B5625501Medicare ID - Type Unspecified
MI5250046OtherBCBS