Provider Demographics
NPI:1821090127
Name:GILBERT, MICHELE AH
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:AH
Last Name:GILBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12201 RENFERT WAY
Mailing Address - Street 2:STE 340
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5369
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12201 RENFERT WAY
Practice Address - Street 2:STE 340
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5369
Practice Address - Country:US
Practice Address - Phone:512-425-3845
Practice Address - Fax:512-425-3888
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0200174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8341K0Medicare ID - Type Unspecified
TXG79718Medicare UPIN