Provider Demographics
NPI:1770521148
Name:GILBERT-JOHNSON, ALINE (MD)
Entity type:Individual
Prefix:
First Name:ALINE
Middle Name:
Last Name:GILBERT-JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALINE
Other - Middle Name:
Other - Last Name:GILBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 577
Mailing Address - Street 2:
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-0577
Mailing Address - Country:US
Mailing Address - Phone:618-985-8221
Mailing Address - Fax:618-985-6860
Practice Address - Street 1:3111 WILLIAMSON COUNTY PKWY
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5235
Practice Address - Country:US
Practice Address - Phone:618-997-3647
Practice Address - Fax:618-998-1328
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361102112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036110211Medicaid
IL640701OtherMEDICARE WPS FFS GROUP
ILCF3444OtherMEDICARE RAILROAD GROUP
IL370966854011Medicaid
IL141967Medicare Oscar/Certification
ILCF3444OtherMEDICARE RAILROAD GROUP
ILK22508Medicare PIN