# TIMOTHY GATES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619467677
- **Authorized official:** TIMOTHY GATES FNP-BC (NURSE PRACTITIONER)
- **Authorized official phone:** (248) 842-3755

## Contact information

- **Practice address:** 16250 NORTHLAND DR STE 369, SOUTHFIELD, MI 48075-5208
- **Practice address phone:** (248) 798-8433
- **Practice address fax:** (248) 487-9410
- **Mailing address:** 14415 WOODMONT AVE, DETROIT, MI 48227-4710

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | — |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 05/15/2018
- **Last updated:** 01/17/2020