Individual
VICTORIA LOCKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
301 GORDON GUTMANN BLVD STE 401, JEFFERSONVILLE, IN 47130-3768
(812) 282-0637
(812) 283-6330
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 559-9337
(502) 559-9337
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
02006862A
IN
390200000X
Student in an Organized Health Care Education/Training Program
5101024084
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300075238
—
IN
01
—
IN2570122
MEDICARE
IN
Enumeration date
06/27/2018
Last updated
04/04/2024
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