Provider Demographics
NPI:1679577282
Name:GOETTLER, GAIL LYNNE (MD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:LYNNE
Last Name:GOETTLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 SIERRA DR STE 400
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7241
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:
Practice Address - Street 1:1030 E COUNTY LINE ROAD SUITE B-2
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46277-0001
Practice Address - Country:US
Practice Address - Phone:317-887-6060
Practice Address - Fax:317-859-5946
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036971208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000087993OtherANTHEM
IN100351160Medicaid