Individual
GERARD I DUPRAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
621 MEMORIAL DR, SUITE 312, SOUTH BEND, IN 46601-1063
(574) 647-5200
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
01036966
IN
2085R0204X
Vascular & Interventional Radiology Physician
Primary
01036966
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000773328
BCBS VASCULAR IR
IN
01
—
000000951356
BCBS BMG VEIN SPECIALIST
IN
05
—
100469090
—
IN
01
—
P01088785
RR MEDICARE
IN
Enumeration date
09/12/2005
Last updated
12/06/2017
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