Individual
THOMAS GAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
620 W EDISON RD, SUITE 110, MISHAWAKA, IN 46545-2784
(574) 258-1100
(574) 259-1101
Mailing address
620 W EDISON RD, SUITE 110, MISHAWAKA, IN 46545-2784
(574) 258-1100
(574) 258-1101
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
336075522
IL
2085R0204X
Vascular & Interventional Radiology Physician
036-112490
IL
Other
Enumeration date
07/23/2008
Last updated
04/23/2021
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