Provider Demographics
NPI:1811977671
Name:FUERSTE, GRETCHEN (MD)
Entity type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:
Last Name:FUERSTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20922 COUNTRY SQUIRE LN
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-8002
Mailing Address - Country:US
Mailing Address - Phone:563-552-2566
Mailing Address - Fax:
Practice Address - Street 1:2140 JFK RD
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-3883
Practice Address - Country:US
Practice Address - Phone:563-582-0769
Practice Address - Fax:563-582-5772
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22454207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31479600Medicaid
IA1072231Medicaid
D89627Medicare UPIN
WI31479600Medicaid