Provider Demographics
NPI:1134185051
Name:GERKEN, ANDREW S (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:S
Last Name:GERKEN
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 1:4750 HEMPSTEAD STATION DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5164
Mailing Address - Country:US
Mailing Address - Phone:800-875-0136
Mailing Address - Fax:937-619-4231
Practice Address - Street 1:629 N SANDUSKY AVE
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820-1821
Practice Address - Country:US
Practice Address - Phone:419-562-4677
Practice Address - Fax:419-562-0987
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301502408207P00000X, 207Q00000X
OH35082874207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00205797OtherRR MEDICARE - GREENFIELD
OHP00263123OtherRR MEDICARE FOR BUCYRUS
OHP00143218OtherRR MEDICARE FOR MADISON
OH000000339750OtherBCBS FOR MADISON
OH000000384551OtherBCBS FOR GALION
OH000000346397OtherBCBS FOR GREENFIELD
OH2466700Medicaid
P00306579OtherRR
OH000000362624OtherBCBS FOR BUCYRUS
000000384661OtherBCBS GALION
H56932Medicare UPIN
P00306579OtherRR
000000384661OtherBCBS GALION
OH000000346397OtherBCBS FOR GREENFIELD
OHP00143218OtherRR MEDICARE FOR MADISON
GE4129556Medicare PIN