Individual
BRUCE M. GOENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11725 N ILLINOIS ST, STE 325, CARMEL, IN 46032-3002
(317) 688-5800
(317) 688-5805
Mailing address
250 N SHADELAND AVE, STE 130 PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01027055A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000313300
ANTHEM
IN
05
—
100062890
—
IN
01
—
P00081860
RR MEDICARE
IN
01
—
P00887146
RAILROAD MEDICARE PTAN
IN
Enumeration date
07/28/2006
Last updated
01/31/2014
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