Healthcare Provider Details

I. General information

NPI: 1407855802
Provider Name (Legal Business Name): GEOFFREY C CLY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13861 OLIO RD
FISHERS IN
46037-3487
US

IV. Provider business mailing address

3926 NEW VISION DR
FORT WAYNE IN
46845-1712
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-7136
  • Fax: 317-338-6359
Mailing address:
  • Phone: 260-266-8210
  • Fax: 260-458-5636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01057955A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: