Individual
MARK C. GORRIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
714 N. SENATE AVE, SUITE 100, INDIANAPOLIS, IN 46202-3297
(317) 944-1837
(317) 715-6415
Mailing address
250 N SHADELAND AVENUE, SUITE 130, INDIANAPOLIS, IN 46219-4959
(317) 963-0860
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
02003492A
IN
2085R0202X
Diagnostic Radiology Physician
36113813
IL
2085R0204X
Vascular & Interventional Radiology Physician
Primary
OS18237
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000618591
ANTHEM BCBS
IN
05
—
112658900
—
FL
05
—
200946010
—
IN
01
—
P00787056
RAILROAD MEDICARE
IN
Enumeration date
08/17/2006
Last updated
09/27/2022
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