Healthcare Provider Details

I. General information

NPI: 1538152392
Provider Name (Legal Business Name): GERIG SURGICAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 S MAIN ST SUITE A
GOSHEN IN
46526-5232
US

IV. Provider business mailing address

2006 S MAIN ST SUITE A
GOSHEN IN
46526-5232
US

V. Phone/Fax

Practice location:
  • Phone: 574-535-9100
  • Fax: 574-535-1020
Mailing address:
  • Phone: 574-535-9100
  • Fax: 574-535-1020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL A DIENER
Title or Position: PRESIDENT
Credential: MD
Phone: 574-535-9100