Provider Demographics
NPI:1265429542
Name:BOBELDYK, GERARD L (MD)
Entity type:Individual
Prefix:
First Name:GERARD
Middle Name:L
Last Name:BOBELDYK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16472 LAUREL RD
Mailing Address - Street 2:
Mailing Address - City:ST JOSEPH
Mailing Address - State:MN
Mailing Address - Zip Code:56374
Mailing Address - Country:US
Mailing Address - Phone:320-252-5131
Mailing Address - Fax:320-240-2118
Practice Address - Street 1:16472 LAUREL RD
Practice Address - Street 2:
Practice Address - City:ST JOSEPH
Practice Address - State:MN
Practice Address - Zip Code:56374
Practice Address - Country:US
Practice Address - Phone:320-252-5131
Practice Address - Fax:320-240-2118
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN26110207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
6D057BOOtherBLUE CROSS BLUE SHIELD
110104504OtherRR MEDICARE
986003OtherPREFERRED ONE
HP22731OtherHEALTH PARTNERS
600903OtherARAZ GROUP/AMERICAS PPO
2114072OtherFIRST HEALTH PLAN
0400499OtherMEDICA HEALTH PLANS
110893OtherU-CARE
037802000OtherMEDICAL ASSISTANCE (MA)
986003OtherPREFERRED ONE
HP22731OtherHEALTH PARTNERS