Provider Demographics
NPI:1831169507
Name:HAUTMAN, GERALD D (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:D
Last Name:HAUTMAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:952-883-5375
Mailing Address - Fax:651-653-2111
Practice Address - Street 1:1430 HWY 96 E - MAIL STOP 32300A
Practice Address - Street 2:HEALTHPARTNERS WHITE BEAR LAKE CLINIC
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-7693
Practice Address - Country:US
Practice Address - Phone:651-426-1980
Practice Address - Fax:651-653-2111
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2011-11-30
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Provider Licenses
StateLicense IDTaxonomies
MI4301056360207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG44570Medicare UPIN