Provider Demographics
NPI:1225452956
Name:GATES, KATE MARIE (DO)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:MARIE
Last Name:GATES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:MARIE
Other - Last Name:CLENDENEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:333 N SUMMIT ST FL 7
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1531
Mailing Address - Country:US
Mailing Address - Phone:419-291-2003
Mailing Address - Fax:419-479-6977
Practice Address - Street 1:2213 CHERRY ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2603
Practice Address - Country:US
Practice Address - Phone:419-251-6596
Practice Address - Fax:419-251-6849
Is Sole Proprietor?:No
Enumeration Date:2014-02-17
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010263722086S0129X
390200000X
OH34.0141262086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program