Provider Demographics
NPI:1457310195
Name:POLITZER, GREGORY AUSTIN (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:AUSTIN
Last Name:POLITZER
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 1:301 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:NORTH VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47265-1030
Mailing Address - Country:US
Mailing Address - Phone:812-352-4300
Mailing Address - Fax:812-352-4301
Practice Address - Street 1:301 HENRY ST
Practice Address - Street 2:
Practice Address - City:NORTH VERNON
Practice Address - State:IN
Practice Address - Zip Code:47265-1030
Practice Address - Country:US
Practice Address - Phone:812-352-4300
Practice Address - Fax:812-352-4301
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2011-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39720207Q00000X
IN01069078A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64109325Medicaid
IN200531810Medicaid
OH2618993Medicaid
KY0793822Medicare PIN
KY64109325Medicaid
I39573Medicare UPIN
OH2618993Medicaid