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Organization

TIMOTHY GATES LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TIMOTHY GATES FNP-BC (NURSE PRACTITIONER)
(248) 842-3755
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
363LA2200X
Adult Health Nurse Practitioner
363LF0000X
Family Nurse Practitioner

Other

Enumeration date
05/15/2018
Last updated
01/17/2020
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