Provider Demographics
NPI:1679007116
Name:GATLIN, TISCHELLE (MD)
Entity Type:Individual
Prefix:
First Name:TISCHELLE
Middle Name:
Last Name:GATLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 MADISON ST STE 120
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6652
Mailing Address - Country:US
Mailing Address - Phone:815-725-2699
Mailing Address - Fax:
Practice Address - Street 1:301 MADISON ST STE 120
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6652
Practice Address - Country:US
Practice Address - Phone:815-725-2699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036155830207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology