MEDICARE: THOMAS A GARDNER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	01051214A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000109044	OTHER	IN	ANTHEM PIN

General Provider Information

NPI Number	:	1376538066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS A GARDNER MD

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	535 BARNHILL DR
Second Line	:	RT 420
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5112
Country	:	US
Telephone Number	:	317-278-3434
Fax Number	:	317-274-0174

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	03/08/2025

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Directions to “ THOMAS A GARDNER MD” Practice Location

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