1376625533 NPI number — GILBERT NEUROLOGICAL ASSOC PLLC

Table of content: (NPI 1376625533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376625533 NPI number — GILBERT NEUROLOGICAL ASSOC PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GILBERT NEUROLOGICAL ASSOC PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AMERICAN INSTITUTE OF NEUROLOGICAL DISORDERS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376625533
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18535 W 12 MILE RD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
LATHRUP VILLAGE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48076-2676
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-552-3734
Provider Business Mailing Address Fax Number:
248-552-3736

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18535 W 12 MILE RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LATHRUP VILLAGE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48076-2676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-552-3734
Provider Business Practice Location Address Fax Number:
248-552-3736
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GILBERT
Authorized Official First Name:
NEIL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
248-552-3734

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  4301072532 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1106303932 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1106303932 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 130F338870 . This is a "BC/BS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 12440 . This is a "CAPE HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4717514 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: H89219 . This is a "HAP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 130F338870 . This is a "BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 146353 . This is a "GREAT LAKES HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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