Healthcare Provider Details

I. General information

NPI: 1063627479
Provider Name (Legal Business Name): ERICA M GIBLIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13450 N MERIDIAN ST STE 135
CARMEL IN
46032-1546
US

IV. Provider business mailing address

13450 N MERIDIAN ST STE 135
CARMEL IN
46032-1473
US

V. Phone/Fax

Practice location:
  • Phone: 317-582-9355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD75370
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01074066A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: