Individual
SEAN DAVID GUSSICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1701 N SENATE BLVD, RADIOLOGY DEPT, INDIANAPOLIS, IN 46202-1239
(317) 962-5740
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01063216A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200988960
—
IN
01
—
P00851233
RAILROAD MEDICARE
IN
Enumeration date
07/02/2008
Last updated
01/29/2021
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