Provider Demographics
NPI:1255348454
Name:PADULA, GILBERT (MD)
Entity type:Individual
Prefix:
First Name:GILBERT
Middle Name:
Last Name:PADULA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6935 RELIABLE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0001
Mailing Address - Country:US
Mailing Address - Phone:616-897-0995
Mailing Address - Fax:616-897-0986
Practice Address - Street 1:9485 MENTOR AVE STE 3
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-8711
Practice Address - Country:US
Practice Address - Phone:440-205-5755
Practice Address - Fax:440-205-5789
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010699932085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4435150Medicaid
MI4435150Medicaid
MIH72007Medicare UPIN