Individual
DR. GARY S MIDLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1001 HADLEY RD, SUITE 101, MOORESVILLE, IN 46158-1794
(317) 831-9340
(317) 834-5768
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02000703A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100434160A
—
IN
Enumeration date
11/15/2005
Last updated
03/15/2021
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