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General NPI Number Information
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NPI Number | 1508822255
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Entity Type | Individual
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Provider Name | MARC W GERDISCH MD
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Gender | Male
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Dates
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Enumeration Date | 04/21/2006
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Last Update Date | 06/17/2024
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Provider Practice Location Address
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Address Line | 8051 S EMERSON AVE STE 365
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City | INDIANAPOLIS
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State | IN
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Zip | 46237-0011
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Country | US
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Telephone | 178-512-3313
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Fax |
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Provider Business Mailing Address
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Address Line | 2650 WARRENVILLE RD SUITE 280
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City | DOWNERS GROVE
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State | IL
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Zip | 60515
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Country | US
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Telephone | 630-324-7900
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Fax | 630-324-7942
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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 | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 01048049A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 036079121
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License Number State | IL
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