Provider Demographics
NPI:1982321113
Name:GILBERT, GARY
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:GILBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 N 94TH ST APT 206
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-1565
Mailing Address - Country:US
Mailing Address - Phone:414-394-2232
Mailing Address - Fax:
Practice Address - Street 1:4419 N 25TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-6101
Practice Address - Country:US
Practice Address - Phone:414-394-2232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver