Provider Demographics
NPI:1700888948
Name:ADSIT, GARY LYNN (DPM)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:LYNN
Last Name:ADSIT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 W KEM RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-1548
Mailing Address - Country:US
Mailing Address - Phone:765-664-0107
Mailing Address - Fax:765-664-6541
Practice Address - Street 1:1900 W KEM RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-1548
Practice Address - Country:US
Practice Address - Phone:765-664-0107
Practice Address - Fax:765-664-6541
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000307213EP1101X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000083983OtherBLUE CROSS BLUE SHIELD
IN351433975OtherTRICARE
IN000000083983OtherBLUE CROSS BLUE SHIELD
IN293090BMedicare ID - Type Unspecified
IN351433975OtherTRICARE