MEDICARE: JODI DANIELLE GERDES 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	174400000X	Specialist	51623	TN
2	2086S0129X	Vascular Surgery Physician	71331	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6086635	OTHER	TN	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033313127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODI DANIELLE GERDES M.D.

Provider Business Mailing Address
First Line	:	3024 BUSINESS PARK CIR
Second Line	:
City	:	GOODLETTSVILLE
State	:	TN
Zip	:	37072-3132
Country	:	US
Telephone Number	:	615-851-6033
Fax Number	:	615-851-2018

Provider Business Practice Location Address
First Line	:	225 SMITH AVE N STE 500
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55102-2545
Country	:	US
Telephone Number	:	651-292-0007
Fax Number	:

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

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	06/15/2022

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