Provider Demographics
NPI:1952367641
Name:GAMBLA, MICHAEL T (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:T
Last Name:GAMBLA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:701 TECH CENTER DR STE 250
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1987
Mailing Address - Country:US
Mailing Address - Phone:614-944-4800
Mailing Address - Fax:614-944-4750
Practice Address - Street 1:350 W WILSON BRIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2590
Practice Address - Country:US
Practice Address - Phone:614-796-2900
Practice Address - Fax:614-796-2901
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2020-02-13
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Provider Licenses
StateLicense IDTaxonomies
OH35073770208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2242755Medicaid
OH4048424Medicare PIN
OH2242755Medicaid