Provider Demographics
NPI:1821089681
Name:GOLLNICK, KRISTEN W (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:W
Last Name:GOLLNICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8890 E 116TH ST
Practice Address - Street 2:SUITE 260
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2856
Practice Address - Country:US
Practice Address - Phone:317-621-8953
Practice Address - Fax:317-621-4456
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055066A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2649965001OtherCIGNA HEALTHCARE
IN7622421OtherAETNA HEALTH PLAN
IN201316010Medicaid
IN000000238184OtherANTHEM HEALTH PLAN
INP01588216OtherRR MEDICARE
IN266180616Medicare PIN