Provider Demographics
NPI:1366987513
Name:GARY GETTELFINGER MD DABPM LLC
Entity type:Organization
Organization Name:GARY GETTELFINGER MD DABPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GETTELFINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-476-0352
Mailing Address - Street 1:1619 N PRAIRIE GREEN CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-8701
Mailing Address - Country:US
Mailing Address - Phone:812-353-2700
Mailing Address - Fax:
Practice Address - Street 1:1619 N PRAIRIE GREEN CT
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-8701
Practice Address - Country:US
Practice Address - Phone:812-353-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-27
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036884208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN547540KOtherMEDICARE PTAN
IN200039570Medicaid