Provider Demographics
NPI: | 1508885849 |
---|---|
Name: | GILBIRDS, WILLIAM M II (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | WILLIAM |
Middle Name: | M |
Last Name: | GILBIRDS |
Suffix: | II |
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: | 901 E.104TH ST |
Mailing Address - Street 2: | MAILSTOP 400N |
Mailing Address - City: | KANSAS CITY |
Mailing Address - State: | MO |
Mailing Address - Zip Code: | 64131-4517 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 816-502-7104 |
Mailing Address - Fax: | 816-932-9670 |
Practice Address - Street 1: | 5844 NW BARRY RD |
Practice Address - Street 2: | SUITE 110 |
Practice Address - City: | KANSAS CITY |
Practice Address - State: | MO |
Practice Address - Zip Code: | 64154-1465 |
Practice Address - Country: | US |
Practice Address - Phone: | 816-880-6100 |
Practice Address - Fax: | 816-746-1226 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-07-18 |
Last Update Date: | 2018-02-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MO | R2E15 | 207Q00000X, 207QG0300X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | |
No | 207QG0300X | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MO | 203175419 | Medicaid | |
MO | H715142 | Medicare ID - Type Unspecified |