Provider Demographics
NPI:1306934526
Name:DEDINSKY, GREGORY K (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:K
Last Name:DEDINSKY
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 1:4403 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-3533
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2326 18TH ST
Practice Address - Street 2:STE 130
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5359
Practice Address - Country:US
Practice Address - Phone:812-376-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036817A208G00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000083890OtherANTHEM
CB8082OtherTRICARE
IN100368780Medicaid
IN4125843OtherAETNA
IN399009OtherWELLCARE
INP01191761OtherRR MEDICARE PTAN
IN000000569472OtherANTHEM
E36271Medicare UPIN
INP01191761OtherRR MEDICARE PTAN
IN100368780Medicaid
IN266180109Medicare PIN
IN074910GMedicare PIN
IN0600133952Medicare PIN