Individual
GARY A MARCOTTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
15900 W 101ST AVE, DYER, IN 46311
(219) 365-6333
(219) 365-8291
Mailing address
15900 W 101ST AVE, MARCOTTE MEDICAL GROUP, SC, DYER, IN 46311
(219) 365-6333
(219) 365-8291
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02000603A
IN
207Q00000X
Family Medicine Physician
036057151
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000388132
ANTHEM
IN
01
—
036057151
ILLINOIS PUBLIC AID
IL
05
—
036057151
—
IL
01
—
080191174
RAILROAD
IL
05
—
200211720A
—
IN
01
—
9930277
BCBS
IL
01
—
P00310539
RAILROAD
IN
Enumeration date
05/23/2006
Last updated
03/03/2010
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