Individual
LISA K GERDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
508 TENTH STREET, WORTHINGTON, MN 56187-2343
(507) 372-2921
(507) 372-1815
Mailing address
508 TENTH STREET, WORTHINGTON, MN 56187-2343
(507) 372-2921
(507) 372-1815
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
40273
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
125555
UCARE
MN
05
—
1926113
—
IA
01
—
61A98GE
BCBS MPIN
MN
Enumeration date
10/03/2006
Last updated
04/01/2008
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