Provider Demographics
NPI:1083749451
Name:MICHAEL M GELBORT INC
Entity Type:Organization
Organization Name:MICHAEL M GELBORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:GELBORT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:815-230-2262
Mailing Address - Street 1:2714 CATON FARM RD
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-1309
Mailing Address - Country:US
Mailing Address - Phone:815-230-2262
Mailing Address - Fax:
Practice Address - Street 1:2714 CATON FARM RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-1309
Practice Address - Country:US
Practice Address - Phone:815-230-2262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL07100400103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9904511OtherBLUE CROSS BLUE SHIELD
IL212730Medicare ID - Type Unspecified
IL9904511OtherBLUE CROSS BLUE SHIELD