Provider Demographics
NPI:1619065455
Name:GERBERI, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:GERBERI
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 1:1002 GREDEN SHORES DR.
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081
Mailing Address - Country:US
Mailing Address - Phone:815-441-2186
Mailing Address - Fax:
Practice Address - Street 1:1002 GREDEN SHORES DR.
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081
Practice Address - Country:US
Practice Address - Phone:815-441-2186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036078946207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036078946Medicaid
IL012790OtherHEATH ALLIANCE MEDICAL
IL9815737OtherBLUE CROSS BLUE SHIELD
IL012790OtherHEATH ALLIANCE MEDICAL
IL9815737OtherBLUE CROSS BLUE SHIELD
ILL06028Medicare PIN