Individual
DR. KENNETH L GERDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11155 DUNN RD, SUITE 211N, SAINT LOUIS, MO 63136-6150
(314) 432-2580
(314) 991-8960
Mailing address
PO BOX 1209, MARYLAND HEIGHTS, MO 63043-0209
(314) 432-2580
(314) 991-8960
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
036-082405
IL
207RN0300X
Nephrology Physician
Primary
R6G82
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202034729
TRICARE WEST PROV#
MO
05
—
202382115
—
MO
01
—
23548
BCBS PROV#
MO
01
—
237776
GHP/CMR PROV#
MO
01
—
733423
HEALTHLINK PROV#
MO
01
—
P00278412
RR MCR PROV#
MO
Enumeration date
06/12/2006
Last updated
12/10/2024
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