Provider Demographics
NPI:1760513162
Name:GILBREATH, MICHAEL JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:GILBREATH
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 1:35 BILL FRIES DR
Mailing Address - Street 2:BLGD F
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2730
Mailing Address - Country:US
Mailing Address - Phone:843-681-6668
Mailing Address - Fax:843-681-3295
Practice Address - Street 1:35 BILL FRIES DR
Practice Address - Street 2:BLGD F
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-2730
Practice Address - Country:US
Practice Address - Phone:843-681-6668
Practice Address - Fax:843-681-3295
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21106207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2995Medicaid
SCH01330Medicare UPIN
SCGP2995Medicaid
SC6832Medicare PIN