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General NPI Number Information
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NPI Number | 1235143512
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Entity Type | Individual
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Provider Name | GREGORY W BOAKE D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 07/29/2006
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Last Update Date | 02/09/2021
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Provider Practice Location Address
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Address Line | 10122 E 10TH ST STE 230
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City | INDIANAPOLIS
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State | IN
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Zip | 46229-2664
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Country | US
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Telephone | 317-355-7356
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 330
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City | FORTVILLE
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State | IN
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Zip | 46040-0330
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Country | US
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Telephone | 317-863-2556
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Fax | 317-203-0420
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 070001028A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 070001028A
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License Number State | IN
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