1790570604 NPI number — IAN WALTON GILBERT DO, MS

Table of content: IAN WALTON GILBERT DO, MS (NPI 1790570604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790570604 NPI number — IAN WALTON GILBERT DO, MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILBERT
Provider First Name:
IAN
Provider Middle Name:
WALTON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO, MS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1790570604
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
275 MICHIGAN ST NE, GRAND RAPIDS, MI 49503
Provider Second Line Business Mailing Address:
8TH FLOOR
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49503-2531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-391-8810
Provider Business Mailing Address Fax Number:
616-391-8897

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
275 MICHIGAN ST NE FL 8
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49503-2531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-391-8810
Provider Business Practice Location Address Fax Number:
616-391-8897
Provider Enumeration Date:
04/11/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  5151017452 , 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)





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