Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 01070594A | IN |
NPI | 1043339286 |
---|---|
Provider Name | Henry S Gindt |
First Address | Fort Wayne, IN 46804-4701 |
Second Address | Marion, IN 46952-2536 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 10/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201142000 | (05) | IN |