Provider Demographics
NPI:1093797276
Name:GASPARIS, MILTON STANLEY (MD PHD)
Entity Type:Individual
Prefix:
First Name:MILTON
Middle Name:STANLEY
Last Name:GASPARIS
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1352 S LAKE PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-5964
Mailing Address - Country:US
Mailing Address - Phone:219-942-7244
Mailing Address - Fax:219-942-0975
Practice Address - Street 1:1352 S LAKE PARK AVE
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-5964
Practice Address - Country:US
Practice Address - Phone:219-942-7244
Practice Address - Fax:219-942-0975
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037515207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100201630AMedicaid
IN100201630AMedicaid
B61825Medicare UPIN