Provider Demographics
NPI:1659676146
Name:WESTIN, GREGORY GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:GEORGE
Last Name:WESTIN
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 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1801 N SENATE BLVD
Practice Address - Street 2:MPC2, SUITE 3500
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1184
Practice Address - Country:US
Practice Address - Phone:317-962-0280
Practice Address - Fax:347-394-2246
Is Sole Proprietor?:No
Enumeration Date:2011-01-14
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2859372086S0129X
IN01082541A2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300029534Medicaid
IN273010007OtherMEDICARE PTAN
INP02351384OtherRAILROAD PTAN