Provider Demographics
NPI:1558456020
Name:GENTILE, JONATHAN P II (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:P
Last Name:GENTILE
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13225 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5480
Mailing Address - Country:US
Mailing Address - Phone:317-228-7000
Mailing Address - Fax:317-228-2321
Practice Address - Street 1:13225 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5480
Practice Address - Country:US
Practice Address - Phone:317-228-7000
Practice Address - Fax:317-577-0619
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039604A208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000032231OtherM-PLAN PROVIDER NUMBER
IN000000369670OtherANTHEM PROVIDER NUMBER
INP00277537OtherMEDICARE RAILROAD
IN200005430Medicaid
IN000000369670OtherUNICARE PROVIDER NUMBER
IN000000369670OtherANTHEM PROVIDER NUMBER
IN186950KMedicare PIN