Healthcare Provider Details

I. General information

NPI: 1790195303
Provider Name (Legal Business Name): VINCENT GEMMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 12/31/2021
Certification Date: 12/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 INTELLIPLEX DR STE 280
SHELBYVILLE IN
46176-8580
US

IV. Provider business mailing address

2451 INTELLIPLEX DR STE 280
SHELBYVILLE IN
46176-8580
US

V. Phone/Fax

Practice location:
  • Phone: 317-392-0222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01082187A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: