Provider Demographics
NPI:1194771873
Name:GELB, BRIAN (MD)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:GELB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E DIXON AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-1187
Mailing Address - Country:US
Mailing Address - Phone:231-838-2593
Mailing Address - Fax:
Practice Address - Street 1:4170 CEDAR BLUFF DR
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-7627
Practice Address - Country:US
Practice Address - Phone:231-487-2230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBG079468207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104392830Medicaid
H60145Medicare UPIN
M75310009Medicare ID - Type Unspecified