Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 01052849 | IN |
NPI | 1316903511 |
---|---|
Provider Name | Dr. Kevin B. Gebke |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46202-5209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 20/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
068010RR | (02) | IN |
200331600 | (05) | IN |
H39500 | (02) | IN |