Individual
DR. GARY M IDELCHIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1230 E 1ST ST, CASPER, WY 82601-2704
(307) 266-3174
(307) 266-3177
Mailing address
1230 E 1ST ST, CASPER, WY 82601-2704
(307) 266-3174
(307) 266-3177
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
259398
NY
207RI0011X
Interventional Cardiology Physician
Primary
13381A
WY
207RI0011X
Interventional Cardiology Physician
ME133430
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03824182
—
NY
05
—
102451000
—
FL
05
—
157420500
—
WY
Enumeration date
04/28/2009
Last updated
09/27/2022
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