Provider Demographics
NPI:1093715856
Name:GIMBEL, BARRY KENT (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:KENT
Last Name:GIMBEL
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 1:5150 N PORT WASHINGTON RD
Mailing Address - Street 2:STE 249
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-5474
Mailing Address - Country:US
Mailing Address - Phone:414-964-0000
Mailing Address - Fax:414-964-2556
Practice Address - Street 1:5150 N PORT WASHINGTON RD
Practice Address - Street 2:STE 249
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53217-5474
Practice Address - Country:US
Practice Address - Phone:414-964-0000
Practice Address - Fax:414-964-2556
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24375207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30439600Medicaid
WI000046070Medicare PIN
WI000101780Medicare PIN
060022357Medicare PIN
B53081Medicare UPIN