Individual
DR. TRICIA KAYE GIFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4001 W GOELLER BLVD, COLUMBUS, IN 47201-8308
(812) 375-3330
(812) 375-3329
Mailing address
PO BOX 775383, CHICAGO, IL 60677-5383
(812) 376-5315
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01063240
IN
207Q00000X
Family Medicine Physician
36101716
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000991452
ANTHEM PIN
IN
01
—
0004132020
BCBS
IL
05
—
036101716
—
IL
05
—
201311170
—
IN
01
—
L76814
PIN
—
Enumeration date
11/09/2005
Last updated
09/06/2024
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