Provider Demographics
NPI:1508867177
Name:TORKEO, GARY MICHAEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:MICHAEL
Last Name:TORKEO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 W JEFFERSON BLVD
Mailing Address - Street 2:SUITE 175
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-6853
Mailing Address - Country:US
Mailing Address - Phone:260-436-4438
Mailing Address - Fax:260-432-2833
Practice Address - Street 1:4011 W JEFFERSON BLVD
Practice Address - Street 2:SUITE 175
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-6853
Practice Address - Country:US
Practice Address - Phone:260-436-4438
Practice Address - Fax:260-432-2833
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000628A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN480007130OtherRAILROAD MEDICARE
IN100081320Medicaid
IN480007130OtherRAILROAD MEDICARE
INT0136070Medicare ID - Type Unspecified
IN4729940001Medicare NSC
INT34576Medicare UPIN