Individual
MARYELLEN E GUSIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
705 RILEY HOSPITAL DR, SUITE 1300, INDIANAPOLIS, IN 46202-5109
(317) 944-2801
(317) 944-5630
Mailing address
950 N MERIDIAN STREET, SUITE 500 - PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46204-3908
(317) 963-0595
(317) 962-4950
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01069711A
IN
208000000X
Pediatrics Physician
MD053599L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0014850040010
—
PA
05
—
201055470
—
IN
Enumeration date
05/12/2006
Last updated
07/30/2013
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