Basic Information
| Provider Information | |||||||||
| NPI: | 1609868207 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GATZ | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | PATRICK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1040 SIERRA DR | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461437241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175284284 | ||||||||
| FaxNumber: | 3178658355 | ||||||||
| Practice Location | |||||||||
| Address1: | 2421 LAPORTE AVE | ||||||||
| Address2: | |||||||||
| City: | VALPARAISO | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463836914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2194626192 | ||||||||
| FaxNumber: | 2194642585 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2005 | ||||||||
| LastUpdateDate: | 03/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 01049226A | IN | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 01049226A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200233200 | 05 | IN | MEDICAID | 000000721910 | 01 | IN | ANTHEM TRADITIONAL | OTHER |