Provider Demographics
NPI:1700882701
Name:GREER, GERALD KEVIN (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:KEVIN
Last Name:GREER
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 1:6626E 75TH ST 500
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2401 COLUMBUS BLVD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-6455
Practice Address - Country:US
Practice Address - Phone:765-453-1254
Practice Address - Fax:765-864-8732
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047859207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01824440OtherRAILROAD
IN200249990Medicaid
IN266180806Medicare PIN
INM400065589Medicare PIN
IN200249990Medicaid
258230Medicare PIN
INP01824440OtherRAILROAD