Individual
WALLACE JOHN GASIEWICZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10832 WEATHERLY CT, INDIANAPOLIS, IN 46236-8857
(317) 823-9380
Mailing address
10832 WEATHERLY CT, INDIANAPOLIS, IN 46236-8857
(317) 823-9380
Taxonomy
Speciality
Code
Description
License number
State
2083X0100X
Occupational Medicine Physician
Primary
01059216A
IN
Other
Enumeration date
09/25/2007
Last updated
09/25/2007
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