Individual
TIMOTHY A GOEDDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7501 PINE ROYAL DR, INDIANAPOLIS, IN 46256-3264
(317) 201-1190
Mailing address
7501 PINE ROYAL DR, INDIANAPOLIS, IN 46256-3264
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
01039996A
IN
2086X0206X
Surgical Oncology Physician
Primary
01039996A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000775120
ANTHEM
IN
05
—
100441710
—
IN
01
—
4258887
AETNA
IN
01
—
P01347706
MEDICARE RR PTAN
IN
Enumeration date
06/21/2005
Last updated
01/02/2025
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