Provider Demographics
NPI:1023101565
Name:GARDINER, THOMAS KELSEY (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:KELSEY
Last Name:GARDINER
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 1:7100 W ISANOGEL RD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-9307
Mailing Address - Country:US
Mailing Address - Phone:765-289-0939
Mailing Address - Fax:
Practice Address - Street 1:7100 W ISANOGEL RD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-9307
Practice Address - Country:US
Practice Address - Phone:765-289-0939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01025352A207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100105200AMedicaid
INC24606Medicare UPIN