MEDICARE: DR. GARY S CREED 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	207Q00000X	Family Medicine Physician	01022130A	IN

Other Identifiers

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

General Provider Information

NPI Number	:	1821070731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY S CREED MD

Provider Business Mailing Address
First Line	:	PO BOX 664056
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46266-4056
Country	:	US
Telephone Number	:	317-862-6609
Fax Number	:	317-862-4617

Provider Business Practice Location Address
First Line	:	8325 E SOUTHPORT RD
Second Line	:	SUITE 100
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46259-6805
Country	:	US
Telephone Number	:	317-862-6609
Fax Number	:	317-862-4617

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

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	12/11/2009

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