MEDICARE: DR. STEPHANIE M GARDNER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	11015553A	IN
2	390200000X	Student in an Organized Health Care Education/Training Program	01070246A	IN
3	207P00000X	Emergency Medicine Physician	01070246A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01366963	OTHER	IN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538480777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE M GARDNER MD

Provider Business Mailing Address
First Line	:	5262 CARROLLTON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-3181
Country	:	US
Telephone Number	:	210-241-0651
Fax Number	:

Provider Business Practice Location Address
First Line	:	5262 CARROLLTON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-3181
Country	:	US
Telephone Number	:	210-241-0651
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2010
Last Update Date	:	11/20/2014

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