Provider Demographics
NPI:1447399092
Name:VIZE, GARY ELLIOT (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ELLIOT
Last Name:VIZE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8151 IVY KNOLL LN
Mailing Address - Street 2:APT B
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-3736
Mailing Address - Country:US
Mailing Address - Phone:806-438-5454
Mailing Address - Fax:
Practice Address - Street 1:8151 IVY KNOLL LN
Practice Address - Street 2:APT B
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-3736
Practice Address - Country:US
Practice Address - Phone:806-438-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010870292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H75636Medicare UPIN