Provider Demographics
NPI:1487853487
Name:TED H. GABRIELSEN M.D., INC.
Entity Type:Organization
Organization Name:TED H. GABRIELSEN M.D., INC.
Other - Org Name:GABRIELSEN SURGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:H
Authorized Official - Last Name:GABRIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-462-3255
Mailing Address - Street 1:1 MEMORIAL SQ STE 100
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-2819
Mailing Address - Country:US
Mailing Address - Phone:317-462-3255
Mailing Address - Fax:317-462-7648
Practice Address - Street 1:1 MEMORIAL SQ STE 100
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-2819
Practice Address - Country:US
Practice Address - Phone:317-462-3255
Practice Address - Fax:317-462-7648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN320690AMedicare UPIN