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Michael Gernant

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NPI Number Detailed Information

Provider Information:

Name: Michael Gernant
Gender: M
Provider License Number If Given: 36067279

NPI Information:

NPI: 1740274240
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 9/12/2005

Last Update Date: 5/6/2008

Provider Business Mailing Address:

Address: 834 N SEMINARY ST SUITE 102
Galesburg, IL 61401
Phone Number: 3093420194
Fax Number: 3093429759

Provider Business Practice Location Address:

Address: 834 N SEMINARY ST SUITE 102
Galesburg, IL 61401
Phone Number: 3093420194
Fax Number: 3093429759

Provider Taxonomy:

Primary: 207X00000X
Secondary (if any):
State: IL

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