Provider Demographics
NPI:1891795050
Name:GATEWOOD, TIMOTHY C (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:C
Last Name:GATEWOOD
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 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3611 S REED RD
Practice Address - Street 2:SUITE 213
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3806
Practice Address - Country:US
Practice Address - Phone:765-865-6076
Practice Address - Fax:765-865-6077
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045407207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200195990Medicaid
INP01824439OtherRR MEDICARE
INP01270926OtherRR MEDICARE
ING68174Medicare UPIN
IN200195990Medicaid
ININ1663022Medicare PIN