Individual
CUSTODIO A. GARRIDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2708 GUILFORD ST, HUNTINGTON, IN 46750-9701
(260) 355-3900
(260) 355-3079
Mailing address
3926 NEW VISION DR, BLDG. H, FORT WAYNE, IN 46845-1712
(260) 373-9700
(260) 373-9740
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01041472A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000175779
ANTHEM
IN
01
—
000000183201
ANTHEM
IN
01
—
000000570547
ANTHEM
IN
01
—
00001336580 02
UNITED HEALTHCARE
—
01
—
080130069
RAILROAD MEDICARE
IN
05
—
100381020
—
IN
01
—
2822
PHYSICIANS HEALTH PLAN
IN
01
—
3937240017
MEDICARE DMEPOS
IN
01
—
4556205
AETNA
—
Enumeration date
12/08/2005
Last updated
03/24/2016
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