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General NPI Number Information
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NPI Number | 1700888948
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Entity Type | Individual
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Provider Name | GARY LYNN ADSIT D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 06/18/2015
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Provider Practice Location Address
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Address Line | 1900 W KEM RD
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City | MARION
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State | IN
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Zip | 46952-1548
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Country | US
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Telephone | 765-664-0107
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Fax | 765-664-6541
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Provider Business Mailing Address
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Address Line | 1900 W KEM RD
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City | MARION
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State | IN
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Zip | 46952-1548
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Country | US
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Telephone | 765-664-0107
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Fax | 765-664-6541
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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 | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 07000307
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 07000307
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License Number State | IN
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Legacy Identifiers
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Identifier #1
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Identifier Code | 000000083983
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Identifier Type | OTHER
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Identifier State | IN
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Identifier Issuer | BLUE CROSS BLUE SHIELD
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Identifier #2
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Identifier Code | 351433975
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Identifier Type | OTHER
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Identifier State | IN
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Identifier Issuer | TRICARE
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 000000083983
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Identifier Type | OTHER
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Identifier State | IN
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Identifier Issuer | BLUE CROSS BLUE SHIELD
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Identifier #2
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Identifier Code | 351433975
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Identifier Type | OTHER
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Identifier State | IN
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Identifier Issuer | TRICARE
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