Provider Demographics
NPI:1588640825
Name:GATZ, ALAN G (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:G
Last Name:GATZ
Suffix:
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 1:6121 COLERAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-6417
Mailing Address - Country:US
Mailing Address - Phone:513-354-2466
Mailing Address - Fax:513-906-5477
Practice Address - Street 1:6121 COLERAIN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-6417
Practice Address - Country:US
Practice Address - Phone:513-354-2466
Practice Address - Fax:513-906-5477
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.049349207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHN320631OtherWELLCARE NONPAR
OH2424737Medicaid
OH000000531763OtherANTHEM
OHP00442497Medicare PIN
A15851Medicare UPIN
OHN320631OtherWELLCARE NONPAR
IN180190EEMedicare ID - Type Unspecified
OHGA4112927Medicare PIN