Individual
DR. JOHNNY LEE GERARDOT JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5314 LINCOLNWAY E, MISHAWAKA, IN 46544-4249
(574) 584-2812
(574) 584-2813
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-1840
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01084004A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300003090
—
IN
Enumeration date
04/19/2017
Last updated
02/20/2026
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