Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 01025352A | IN |
NPI | 1023101565 |
---|---|
Provider Name | Dr. Thomas Kelsey Gardiner |
First Address | Muncie, IN 47304-9307 |
Second Address | Muncie, IN 47304-9307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 01/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100105200A | (05) | IN |
C24606 | (02) | IN |