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General NPI Number Information
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NPI Number | 1164620720
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Entity Type | Individual
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Provider Name | PATRICK A GERETY MD
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Gender | Male
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Dates
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Enumeration Date | 07/05/2007
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Last Update Date | 09/08/2016
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Provider Practice Location Address
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Address Line | 545 BARNHILL DR EH 232
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-5112
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Country | US
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Telephone | 317-944-3636
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Fax | 317-278-7159
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Provider Business Mailing Address
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Address Line | 545 BARNHILL DR EH 232
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-5112
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Country | US
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Telephone | 317-944-3636
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Fax | 317-278-7159
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 01077425A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MT191327
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License Number State | PA
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