Provider Demographics
NPI:1700946761
Name:FLEER, GERALD KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:KENNETH
Last Name:FLEER
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 1:301 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND CENTER
Mailing Address - State:WI
Mailing Address - Zip Code:53581-1900
Mailing Address - Country:US
Mailing Address - Phone:608-647-6161
Mailing Address - Fax:608-647-3178
Practice Address - Street 1:301 E 2ND ST
Practice Address - Street 2:
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581-1900
Practice Address - Country:US
Practice Address - Phone:608-647-6161
Practice Address - Fax:608-647-3178
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360083431207VG0400X
WI41574-20207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00363287OtherRAILROAD MEDICARE
IL04632076OtherBCBS PROVIDER NUMBER
IL04632076OtherBCBS PROVIDER NUMBER
ILP00363287OtherRAILROAD MEDICARE
ILK25834Medicare PIN
ILF68710Medicare UPIN