Healthcare Provider Details

I. General information

NPI: 1689295479
Provider Name (Legal Business Name): GRANT NORMAN GELLERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2020
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 MISSOURI AVE
JEFFERSONVILLE IN
47130-3725
US

IV. Provider business mailing address

1854 ALFRESCO PL
LOUISVILLE KY
40205-1860
US

V. Phone/Fax

Practice location:
  • Phone: 812-283-2581
  • Fax:
Mailing address:
  • Phone: 317-448-6665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number60244
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01095828A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: