Provider Demographics
NPI:1386646685
Name:GBUR, CAROLYN S (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:S
Last Name:GBUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1601 BRIGHAM DR STE 150
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-7120
Mailing Address - Country:US
Mailing Address - Phone:419-794-7700
Mailing Address - Fax:419-794-7715
Practice Address - Street 1:1601 BRIGHAM DR STE 150
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-7120
Practice Address - Country:US
Practice Address - Phone:419-794-7700
Practice Address - Fax:419-794-7715
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35059568G207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000476153OtherANTHEM
OH01716OtherPARAMOUNT
MI4980027Medicaid
P00431214OtherRRMC
OH4502161OtherAETNA
OH0671705Medicaid
MI4980009Medicaid
MI4980018Medicaid
OH611448753028OtherCARESOURCE
OH0671705Medicaid