Individual
GERALD DWIGHT MICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12400 N MERIDIAN ST STE 100, CARMEL, IN 46032-4601
(317) 582-8900
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01047173A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200454250
—
IN
01
—
DC3600
RAILROAD GROUP
IN
01
—
P00475864
RAILROAD INDIVIDUAL
IN
Enumeration date
04/12/2006
Last updated
12/16/2020
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