Provider Demographics
NPI:1831204916
Name:GERBER, GREG JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:GREG
Middle Name:JAMES
Last Name:GERBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GREGORY
Other - Middle Name:JAMES
Other - Last Name:GERBER
Other - Suffix:
Other - Last Name Type:Doing Business As
Other - Credentials:
Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:414-647-6326
Mailing Address - Fax:414-671-8860
Practice Address - Street 1:146 E GENEVA SQUARE
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147
Practice Address - Country:US
Practice Address - Phone:262-249-5000
Practice Address - Fax:262-249-7107
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23056207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30354480Medicaid
AG9338698OtherDEA NUMBER
WI30354480Medicaid