Provider Demographics
NPI:1710752324
Name:GILBERT, MICHAEL G SR (RT(R)(MR)ARRT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:GILBERT
Suffix:SR
Gender:M
Credentials:RT(R)(MR)ARRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6455 KELMSCOT CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5674
Mailing Address - Country:US
Mailing Address - Phone:520-661-7567
Mailing Address - Fax:
Practice Address - Street 1:6455 KELMSCOT CT
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5674
Practice Address - Country:US
Practice Address - Phone:520-661-7567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-24
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2858662085B0100X
NC2858662471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance Imaging
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging