Provider Demographics
NPI:1235132903
Name:AKRE, THOMAS GERARD (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GERARD
Last Name:AKRE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 N EDDY ST STE 230
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-3096
Mailing Address - Country:US
Mailing Address - Phone:574-247-4667
Mailing Address - Fax:574-271-4458
Practice Address - Street 1:211 N EDDY ST STE 230
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-3096
Practice Address - Country:US
Practice Address - Phone:574-247-4667
Practice Address - Fax:574-271-4458
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2023-03-21
Deactivation Date:2006-03-29
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
IN02002335A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000341272OtherANTHEM
IN200335260AMedicaid
INH39757Medicare UPIN
IN5287930001Medicare NSC
IN219660AMedicare ID - Type Unspecified