Provider Demographics
NPI:1871504878
Name:GITERSONKE, ALAN RICHARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:RICHARD
Last Name:GITERSONKE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 CORPORATE CTR
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-4192
Mailing Address - Country:US
Mailing Address - Phone:618-931-3338
Mailing Address - Fax:618-931-4905
Practice Address - Street 1:2412 CORPORATE CTR
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-4192
Practice Address - Country:US
Practice Address - Phone:618-931-3338
Practice Address - Fax:618-931-4905
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL732671Medicare PIN
ILT38313Medicare UPIN
IL0394750001Medicare NSC
IL0394750002Medicare NSC