Provider Demographics
NPI:1740274240
Name:GERNANT, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:GERNANT
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 1:834 N SEMINARY ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-2852
Mailing Address - Country:US
Mailing Address - Phone:309-342-0194
Mailing Address - Fax:309-342-9759
Practice Address - Street 1:834 N SEMINARY ST
Practice Address - Street 2:SUITE 102
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-2852
Practice Address - Country:US
Practice Address - Phone:309-342-0194
Practice Address - Fax:309-342-9759
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36067279207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
200029632OtherRAILROAD MEDICARE
IL036-0672791Medicaid
04815039OtherBLUE CROSS BLUE SHIELD
L62560Medicare ID - Type Unspecified
IL0208220001Medicare NSC
C37339Medicare UPIN