Individual
GREGORY W BOAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
10122 E 10TH ST STE 230, INDIANAPOLIS, IN 46229-2664
(317) 355-7356
Mailing address
PO BOX 330, FORTVILLE, IN 46040-0330
(317) 863-2556
(317) 203-0420
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
070001028A
IN
213ES0103X
Foot & Ankle Surgery Podiatrist
070001028A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070001028A
PODIATRIST LICENSE
IN
05
—
20087023
—
IN
01
—
5324290003
DME ES
—
01
—
5324290004
DME BR
—
01
—
5324290005
DME AC
—
01
—
5324290006
DME MC
—
01
—
5324290007
DME WV
—
01
—
5324290008
DME FC
—
Enumeration date
07/29/2006
Last updated
02/09/2021
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