Provider Demographics
NPI:1184078909
Name:GILLIATTE, MICHELLE THERESE (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:THERESE
Last Name:GILLIATTE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7535 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-3064
Mailing Address - Country:US
Mailing Address - Phone:317-379-4465
Mailing Address - Fax:
Practice Address - Street 1:12091 N STATE ROAD 37
Practice Address - Street 2:
Practice Address - City:ELWOOD
Practice Address - State:IN
Practice Address - Zip Code:46036-8986
Practice Address - Country:US
Practice Address - Phone:765-298-2800
Practice Address - Fax:765-298-2820
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01080629A207QB0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
70031767OtherAMERICAN BOARD OF OBESITY MEDICINE ID