Provider Demographics
NPI:1427676634
Name:GILBERT, UNDRANITA
Entity type:Individual
Prefix:
First Name:UNDRANITA
Middle Name:
Last Name:GILBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12077 STERN DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-9442
Mailing Address - Country:US
Mailing Address - Phone:317-628-1475
Mailing Address - Fax:
Practice Address - Street 1:12077 STERN DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-9442
Practice Address - Country:US
Practice Address - Phone:317-628-1475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies