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NPI Code Detail

MEDICARE: DIANE CAROL GIBBS MD

MEDICARE: DIANE CAROL GIBBS 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
1207LC0200XCritical Care Medicine (Anesthesiology) Physician01027979IN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588665988
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANE CAROL GIBBS MD
Provider Business Mailing Address
First Line : 8840 COMMERCE PARK PL STE E
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-3129
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10580 N MERIDIAN ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46290-1028
Country : US
Telephone Number : 317-583-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2005
Last Update Date : 12/15/2014

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