Individual
JUSTINA M GIROD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3534 BROOKLYN AVE, FORT WAYNE, IN 46809-1361
(260) 478-5250
(260) 478-5258
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01058149A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000359608
BLUE CROSS BLUE SHIELD
—
01
—
1100065412
ANTHEM PTAN
IN
05
—
200475910
—
IN
01
—
P00967448
RAILROAD MEDICARE
IN
Enumeration date
11/03/2005
Last updated
12/30/2024
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