Individual
MARK W GERACI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
550 UNIVERSITY BLVD, INDIANAPOLIS, IN 46202-5149
(317) 994-5000
(317) 944-1289
Mailing address
250 N SHADELAND AVE, SUITE 130 - PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
01075552A
IN
207RP1001X
Pulmonary Disease Physician
Primary
01075552A
IN
207RP1001X
Pulmonary Disease Physician
30744
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01307446
—
CO
05
—
201308110
—
IN
Enumeration date
10/13/2006
Last updated
08/26/2015
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