Provider Demographics
NPI:1043339286
Name:GINDT, HENRY S (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:S
Last Name:GINDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9515 LEDGE WOOD CT
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-4701
Mailing Address - Country:US
Mailing Address - Phone:901-606-3847
Mailing Address - Fax:
Practice Address - Street 1:1136 N BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-2536
Practice Address - Country:US
Practice Address - Phone:765-660-7440
Practice Address - Fax:765-662-4715
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01070594A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201142000Medicaid
IN296260006Medicare PIN