Provider Demographics
NPI:1346322005
Name:GABRILOVICH, MICHAEL I (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:I
Last Name:GABRILOVICH
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 1:25 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-1496
Mailing Address - Country:US
Mailing Address - Phone:513-893-5864
Mailing Address - Fax:513-893-5865
Practice Address - Street 1:25 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-1496
Practice Address - Country:US
Practice Address - Phone:513-893-5864
Practice Address - Fax:513-893-5865
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.085432207RP1001X, 207RC0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2694722Medicaid
WII24862Medicare UPIN
OH2694722Medicaid