Individual
MARILYN D GATELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
13100 E 136TH ST, STE 1200, FISHERS, IN 46037-9417
(317) 678-3100
(317) 678-3108
Mailing address
250 N SHADELAND AVE, STE 130 PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10000263
IN
Other
Enumeration date
06/10/2006
Last updated
02/12/2021
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