Provider Demographics
NPI:1609868207
Name:GATZ, JEFFREY PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:PATRICK
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:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:2421 LAPORTE AVE
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-6914
Practice Address - Country:US
Practice Address - Phone:219-462-6192
Practice Address - Fax:219-464-2585
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01049226A208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200233200Medicaid
IN000000721910OtherANTHEM TRADITIONAL
IN000000721910OtherANTHEM TRADITIONAL
G94142Medicare UPIN
IN202790BBBMedicare PIN