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1679538581

NPI Code Detail

MEDICARE: HEIDI S GJERSOE M.D.

MEDICARE: HEIDI S GJERSOE M.D.

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	207RG0100X	Gastroenterology Physician	HG060600	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	0M92920001	OTHER	MI	MEDICARE
9	0P56360004	OTHER	MI	MEDICARE 04/25/2008 AND AFTER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1417961137	OTHER	MI	BCBSM - BRONSON
2	4319176	OTHER	MI	AETNA
4	1679538581	OTHER	MI	NPI
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	100987	OTHER	MI	GREAT LAKES HEALTH PLAN
7	1851569958	OTHER	MI	NPI 04/25/2008 AND AFTER
8	HG060600	OTHER	MI	BLUE CROSS BLUE SHIELD
10	100C910690	OTHER	MI	BCBSM
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	100C914640	OTHER	MI	BCBS 04/25/2008 AND AFTER
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679538581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI S GJERSOE M.D.

Provider Business Mailing Address
First Line	:	3304 COOLEY CT
Second Line	:
City	:	PORTAGE
State	:	MI
Zip	:	49024-7430
Country	:	US
Telephone Number	:	269-349-2266
Fax Number	:	269-349-0792

Provider Business Practice Location Address
First Line	:	3304 COOLEY CT
Second Line	:
City	:	PORTAGE
State	:	MI
Zip	:	49024-7430
Country	:	US
Telephone Number	:	269-349-2266
Fax Number	:	269-349-0792

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	12/11/2014

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Directions to “ HEIDI S GJERSOE M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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