Individual
MR. GARY W MISAMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
201 PENNSYLVANIA PARKWAY, SUITE 200, INDIANAPOLIS, IN 46280-2301
(317) 817-1200
(317) 208-1551
Mailing address
201 PENNSYLVANIA PARKWAY, SUITE 200, INDIANAPOLIS, IN 46280-2301
(317) 817-1200
(317) 208-1551
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
01028154A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100461060
—
IN
01
—
200013396
RR MEDICARE
IN
Enumeration date
05/19/2006
Last updated
03/12/2015
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