Healthcare Provider Details

I. General information

NPI: 1083658181
Provider Name (Legal Business Name): KIMBERLY ANNE GERTEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 FRANCE AVE S STE 200
EDINA MN
55435-2141
US

IV. Provider business mailing address

6565 FRANCE AVE S STE 200
EDINA MN
55435-2141
US

V. Phone/Fax

Practice location:
  • Phone: 952-920-2200
  • Fax: 952-920-0866
Mailing address:
  • Phone: 952-920-2200
  • Fax: 952-920-0866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number50643
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number50643
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number50643
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: