Individual
GERALD N MAESAKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
601 STADIUM MALL DR, WEST LAFAYETTE, IN 47907-2052
(765) 494-1700
(765) 496-1227
Mailing address
601 STADIUM MALL DR, WEST LAFAYETTE, IN 47907-2052
(765) 494-1700
(765) 496-1227
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01044360
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200148130
—
IN
Enumeration date
11/09/2005
Last updated
05/08/2009
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