MEDICARE: GERALD B MADER 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	207Q00000X	Family Medicine Physician	01044523	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080090278	OTHER	IN	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1922174234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALD B MADER MD

Provider Business Mailing Address
First Line	:	1155 W JEFFERSON ST
Second Line	:	SUITE 101
City	:	FRANKLIN
State	:	IN
Zip	:	46131-2730
Country	:	US
Telephone Number	:	317-736-6133
Fax Number	:	317-736-6403

Provider Business Practice Location Address
First Line	:	8 N US 31 STE A
Second Line	:
City	:	WHITELAND
State	:	IN
Zip	:	46184-1546
Country	:	US
Telephone Number	:	317-736-6133
Fax Number	:	317-736-6403

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	05/11/2021

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Directions to “ GERALD B MADER MD” Practice Location

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