Provider Demographics
NPI:1932110087
Name:CERNIAK, GERALD H (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:H
Last Name:CERNIAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MAHOMET
Mailing Address - State:IL
Mailing Address - Zip Code:61853-7460
Mailing Address - Country:US
Mailing Address - Phone:913-359-6001
Mailing Address - Fax:913-359-5552
Practice Address - Street 1:601 E MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:MAHOMET
Practice Address - State:IL
Practice Address - Zip Code:61853-7460
Practice Address - Country:US
Practice Address - Phone:913-359-6001
Practice Address - Fax:913-359-5552
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036043379207P00000X, 208600000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036043379OtherLICENSE