Healthcare Provider Details

I. General information

NPI: 1528064029
Provider Name (Legal Business Name): LUIS R GERSTENMAIER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3140 W CENTRAL AVE
TOLEDO OH
43606-2920
US

IV. Provider business mailing address

3140 W CENTRAL AVE
TOLEDO OH
43606-2920
US

V. Phone/Fax

Practice location:
  • Phone: 419-537-5111
  • Fax: 419-537-5131
Mailing address:
  • Phone: 419-537-5111
  • Fax: 419-537-5131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number35036136
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: