Provider Demographics
NPI:1669593604
Name:GIBBS, KATHLEEN PATRICIA BERNICE (MD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:PATRICIA BERNICE
Last Name:GIBBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 933432
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0039
Mailing Address - Country:US
Mailing Address - Phone:937-641-3555
Mailing Address - Fax:937-641-4528
Practice Address - Street 1:3333 W TECH RD STE 120
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-0956
Practice Address - Country:US
Practice Address - Phone:937-748-6116
Practice Address - Fax:937-291-6956
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35088699208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2766449Medicaid
OH35.088699OtherMEDICAL LICENSE