Individual
HEIDI S GJERSOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3304 COOLEY CT, PORTAGE, MI 49024-7430
(269) 349-2266
(269) 349-0792
Mailing address
3304 COOLEY CT, PORTAGE, MI 49024-7430
(269) 349-2266
(269) 349-0792
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
HG060600
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0M92920001
MEDICARE
MI
01
—
0P56360004
MEDICARE 04/25/2008 AND AFTER
MI
01
—
100987
GREAT LAKES HEALTH PLAN
MI
01
—
100C910690
BCBSM
MI
01
—
100C914640
BCBS 04/25/2008 AND AFTER
MI
05
—
104171768
—
MI
01
—
1417961137
BCBSM - BRONSON
MI
01
—
1679538581
NPI
MI
05
—
1679538581
—
MI
01
—
1851569958
NPI 04/25/2008 AND AFTER
MI
01
—
383309299137
CARESOURCE MEDICAID
MI
01
—
4319176
AETNA
MI
01
—
HG060600
BLUE CROSS BLUE SHIELD
MI
Enumeration date
04/20/2006
Last updated
12/11/2014
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