Provider Demographics
NPI:1275735581
Name:GILBERT, JOHN S (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:GILBERT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 PARK PLACE
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545
Mailing Address - Country:US
Mailing Address - Phone:574-366-0240
Mailing Address - Fax:574-366-0218
Practice Address - Street 1:810 PARK PLACE
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545
Practice Address - Country:US
Practice Address - Phone:574-366-0240
Practice Address - Fax:574-366-0218
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2025-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02004142A207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201134970Medicaid
IN201134970Medicaid
IN000000865164OtherBCBS BMG GOSHEN
IN000000884801OtherBCBS BMG THREE RIVERS
INP01293876OtherRR MEDICARE
INMI7204003Medicare PIN
IN201134970Medicaid