Individual
DR. STEPHANIE M GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5262 CARROLLTON AVE, INDIANAPOLIS, IN 46220-3181
(210) 241-0651
Mailing address
5262 CARROLLTON AVE, INDIANAPOLIS, IN 46220-3181
(210) 241-0651
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01070246A
IN
390200000X
Student in an Organized Health Care Education/Training Program
01070246A
IN
390200000X
Student in an Organized Health Care Education/Training Program
11015553A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201075650
—
IN
01
—
P01366963
RAILROAD MEDICARE
IN
Enumeration date
06/22/2010
Last updated
11/20/2014
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