MEDICARE: KRISTIN MARY HILLGAMYER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	01093722A	IN
2	207QS0010X	Sports Medicine (Family Medicine) Physician	01093722A	IN
3	390200000X	Student in an Organized Health Care Education/Training Program

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1104208878	OTHER	IN	ANTHEM PTAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861029571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN MARY HILLGAMYER MD

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	404 E WASHINGTON ST STE A
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-2609
Country	:	US
Telephone Number	:	317-963-2610
Fax Number	:	317-963-2615

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2020
Last Update Date	:	03/17/2026

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