MEDICARE: THOMAS J GERKE MD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	G59290	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265585061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS J GERKE MD INC

Provider Business Mailing Address
First Line	:	4055 E OLYMPIC BLVD
Second Line	:	SUITE 207
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-3329
Country	:	US
Telephone Number	:	323-262-0599
Fax Number	:	323-262-0699

Provider Business Practice Location Address
First Line	:	4055 E OLYMPIC BLVD
Second Line	:	SUITE 207
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-3329
Country	:	US
Telephone Number	:	323-262-0599
Fax Number	:	323-262-0699

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	LEO RENDON
Credential	:
Telephone Number	:	323-262-0599

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	09/16/2008

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