Provider Demographics
NPI:1659333276
Name:GILPATRICK, MICHAEL T (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:T
Last Name:GILPATRICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3266 N MERIDIAN ST
Mailing Address - Street 2:SUITE101
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-5846
Mailing Address - Country:US
Mailing Address - Phone:317-925-0653
Mailing Address - Fax:317-925-0774
Practice Address - Street 1:3266 N MERIDIAN ST
Practice Address - Street 2:SUITE101
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-5846
Practice Address - Country:US
Practice Address - Phone:317-925-0653
Practice Address - Fax:317-925-0774
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01042660A207L00000X, 208D00000X, 207QG0300X, 207Q00000X
IN01042660207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200174080Medicaid
INP01437826OtherRAILROAD MEDICARE
INF89137Medicare UPIN
IN037170G8Medicare PIN
INM38018006Medicare PIN