Provider Demographics
NPI:1386612737
Name:GILBOE, MICHAEL EDWARD (MS, ATC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:EDWARD
Last Name:GILBOE
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39285 N MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60083-9664
Mailing Address - Country:US
Mailing Address - Phone:847-336-7488
Mailing Address - Fax:
Practice Address - Street 1:555 N SHERIDAN RD
Practice Address - Street 2:LAKE FOREST COLLEGE-ATHLETIC DEPARTMENT
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-2338
Practice Address - Country:US
Practice Address - Phone:847-735-5296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960010852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer