Provider Demographics
NPI:1184722076
Name:FROMM, GARY B (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:B
Last Name:FROMM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 N MICHIGAN ST
Mailing Address - Street 2:MEDICAL EDUCATION DEPT MEMORIAL HOSPITAL
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601
Mailing Address - Country:US
Mailing Address - Phone:574-243-4768
Mailing Address - Fax:574-647-3427
Practice Address - Street 1:615 N MICHIGAN ST
Practice Address - Street 2:MEDICAL EDUCATION DEPT MEMORIAL HOSPITAL
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601
Practice Address - Country:US
Practice Address - Phone:574-243-4768
Practice Address - Fax:574-647-3427
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01024475A207RC0200X, 207RP1001X, 261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Not Answered261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
B29395Medicare UPIN
728950Medicare ID - Type Unspecified