Individual
MARK S GRESLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1100 MERCER AVE, DECATUR, IN 46733-2303
(260) 724-2145
(260) 728-3853
Mailing address
PO BOX 151, DECATUR, IN 46733-0151
(260) 724-2145
(260) 728-3853
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01034460A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000087488
ANTHEM PIN
IN
05
—
100146990A
—
IN
01
—
9131
NO. IN PHP
IN
Enumeration date
07/03/2006
Last updated
10/15/2025
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