Provider Demographics
NPI:1538183454
Name:GAMBLE, MICHAEL J (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:GAMBLE
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 1:1605 S STATE ROAD 159
Mailing Address - Street 2:
Mailing Address - City:DUGGER
Mailing Address - State:IN
Mailing Address - Zip Code:47848-8077
Mailing Address - Country:US
Mailing Address - Phone:812-648-2139
Mailing Address - Fax:
Practice Address - Street 1:1185 N 1000 W
Practice Address - Street 2:
Practice Address - City:LINTON
Practice Address - State:IN
Practice Address - Zip Code:47441-5282
Practice Address - Country:US
Practice Address - Phone:812-847-8900
Practice Address - Fax:812-847-5262
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01051056A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN230030CMedicare ID - Type Unspecified