Provider Demographics
NPI:1962471086
Name:GERBERDING, MICHAEL G (CRNA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:GERBERDING
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-0388
Mailing Address - Country:US
Mailing Address - Phone:316-281-3700
Mailing Address - Fax:316-282-4322
Practice Address - Street 1:6100 E CENTRAL AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4237
Practice Address - Country:US
Practice Address - Phone:316-681-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS54384367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS145296OtherBCBS
KS100247780CMedicaid
KS145296Medicare PIN
KSP00322095Medicare PIN
KS043436Medicare ID - Type UnspecifiedMEDICARE NUMBER