Provider Demographics
NPI:1881770733
Name:GULBRANDSON, GILBERT (CO)
Entity type:Individual
Prefix:MR
First Name:GILBERT
Middle Name:
Last Name:GULBRANDSON
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 THREE OAKS RD
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013
Mailing Address - Country:US
Mailing Address - Phone:847-639-4140
Mailing Address - Fax:847-639-4140
Practice Address - Street 1:2615 THREE OAKS RD
Practice Address - Street 2:SUITE 2B
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013
Practice Address - Country:US
Practice Address - Phone:847-639-4140
Practice Address - Fax:847-639-4140
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213000033222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364056537001Medicaid
IL364056537001Medicaid
IL1096910001Medicare NSC