Provider Demographics
NPI:1023086725
Name:GOUL, RHONDA (MD)
Entity type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:
Last Name:GOUL
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 1:5128 E STOP 11 RD STE 38
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-6338
Mailing Address - Country:US
Mailing Address - Phone:317-689-0400
Mailing Address - Fax:317-458-1917
Practice Address - Street 1:5128 E STOP 11 RD STE 38
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-6338
Practice Address - Country:US
Practice Address - Phone:317-689-0400
Practice Address - Fax:317-458-1917
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057938A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01057938AOtherSTATE MEDICAL LICENSE
BG9127817OtherDEA NUMBER
IN01057938BOtherSTATE CSR
BG9127817OtherDEA NUMBER
IN01057938AOtherSTATE MEDICAL LICENSE