MEDICARE: RUSSELL GERALD GELORMINI D.O.

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	2085R0202X	Diagnostic Radiology Physician	OS9283	FL
2	2085R0202X	Diagnostic Radiology Physician	036115069	IL
3	2085R0202X	Diagnostic Radiology Physician	P0590	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932194545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL GERALD GELORMINI D.O.

Provider Business Mailing Address
First Line	:	11995 SINGLETREE LN
Second Line	:	STE 500
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-5347
Country	:	US
Telephone Number	:	952-595-1301
Fax Number	:	612-294-4903

Provider Business Practice Location Address
First Line	:	27817 LEGACY WOODS
Second Line	:
City	:	BOERNE
State	:	TX
Zip	:	78015-4995
Country	:	US
Telephone Number	:	952-595-1100
Fax Number	:	612-294-4903

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	06/19/2025

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