Provider Demographics
NPI:1871823443
Name:DAVID E. GURVIS, DPM, INC., PC
Entity Type:Organization
Organization Name:DAVID E. GURVIS, DPM, INC., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ELLIOTT
Authorized Official - Last Name:GURVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:317-272-0556
Mailing Address - Street 1:8244 E US HIGHWAY 36
Mailing Address - Street 2:SUITE 120
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-9575
Mailing Address - Country:US
Mailing Address - Phone:317-272-0556
Mailing Address - Fax:317-272-7508
Practice Address - Street 1:8244 E US HIGHWAY 36
Practice Address - Street 2:SUITE 120
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-9575
Practice Address - Country:US
Practice Address - Phone:317-272-0556
Practice Address - Fax:317-272-7508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000405A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN10000610100AMedicaid
IN10000610100AMedicaid
IN075410Medicare PIN
INT34524Medicare UPIN