Individual
MR. ADAM GENTRY DETIG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3903 IVORY WAY, INDIANAPOLIS, IN 46237-3433
(815) 677-1075
Mailing address
3903 IVORY WAY, INDIANAPOLIS, IN 46237-3433
(815) 677-1075
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002938A
IN
Other
Enumeration date
03/18/2020
Last updated
08/20/2024
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