Provider Demographics
NPI:1295705168
Name:GILBERT-AHEE, LISA (DO)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GILBERT-AHEE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:GILBERT-CASTRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:30051 SCHOENHERR RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-3124
Mailing Address - Country:US
Mailing Address - Phone:586-552-4848
Mailing Address - Fax:586-552-4893
Practice Address - Street 1:30117 SCHOENHERR RD
Practice Address - Street 2:SUITE 400
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-6851
Practice Address - Country:US
Practice Address - Phone:586-552-4848
Practice Address - Fax:586-552-4893
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012121207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4828344Medicaid
MIM92600032Medicare ID - Type UnspecifiedMEDICARE ID #
G80847Medicare UPIN
MI4828344Medicaid