Healthcare Provider Details

I. General information

NPI: 1427070788
Provider Name (Legal Business Name): STEVEN GATEWOOD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 11/27/2023
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 S 19TH ST
ELWOOD IN
46036-2941
US

IV. Provider business mailing address

6626 E 75TH ST
INDIANAPOLIS IN
46250-2805
US

V. Phone/Fax

Practice location:
  • Phone: 765-298-2800
  • Fax: 765-298-2820
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01028131A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: