Provider Demographics
NPI:1871687087
Name:GIMBEL, MICHAEL JOSEPH III (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:GIMBEL
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1236 E RUSHOLME ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-2473
Mailing Address - Country:US
Mailing Address - Phone:563-324-2992
Mailing Address - Fax:563-888-0499
Practice Address - Street 1:1236 E RUSHOLME ST
Practice Address - Street 2:SUITE 300
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2434
Practice Address - Country:US
Practice Address - Phone:563-324-2992
Practice Address - Fax:563-324-8562
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-02-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA35115207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1871687087Medicaid
P00407321OtherMEDICARE RAILROAD
IA1871687087Medicaid
ILK38984Medicare PIN