Provider Demographics
NPI:1851812937
Name:ROEDEL, GORDON GLENN (MD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:GLENN
Last Name:ROEDEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2223 LIME KILN RD STE 1
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-6213
Mailing Address - Country:US
Mailing Address - Phone:920-430-8113
Mailing Address - Fax:920-430-8122
Practice Address - Street 1:2223 LIME KILN RD STE 1
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6213
Practice Address - Country:US
Practice Address - Phone:920-430-8113
Practice Address - Fax:920-430-8122
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE8109207X00000X
WI82150207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery