Healthcare Provider Details

I. General information

NPI: 1689485294
Provider Name (Legal Business Name): GINA FIKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 01/15/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2032 S J ST
ELWOOD IN
46036-2955
US

IV. Provider business mailing address

7425 WESTFIELD BLVD
INDIANAPOLIS IN
46240-3056
US

V. Phone/Fax

Practice location:
  • Phone: 317-918-2689
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: