Individual
GARY BERUBE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1270 E STATE ROAD 205 STE 210, SUITE 210, COLUMBIA CITY, IN 46725-8506
(260) 248-9230
(260) 248-9249
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01048413A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000111719
ANTHEM
IN
01
—
000000570537
ANTHEM
IN
01
—
00001071373
UNITED HEALTHCARE
—
01
—
080130068
RAILROAD MEDICARE
IN
05
—
200210030
—
IN
01
—
3937240002
MEDICARE DMEPOS
IN
01
—
3937240025
MEDICARE DMEPOS
IN
01
—
4410292
AETNA
—
01
—
9360
PHYSICIANS HEALTH PLAN
IN
Enumeration date
12/05/2005
Last updated
11/15/2022
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