Provider Demographics
NPI:1033109798
Name:GIBSON, MILTON E (MD)
Entity Type:Individual
Prefix:DR
First Name:MILTON
Middle Name:E
Last Name:GIBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 WHISPERING PINES CT
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-1584
Mailing Address - Country:US
Mailing Address - Phone:574-286-0491
Mailing Address - Fax:574-291-8797
Practice Address - Street 1:1920 WHISPERING PINES CT
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-1584
Practice Address - Country:US
Practice Address - Phone:574-286-0491
Practice Address - Fax:574-291-8797
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01020790A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100326270Medicaid
IN146470A3Medicare ID - Type Unspecified