Provider Demographics
NPI:1962080697
Name:GILBERT, MICHAEL JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:GILBERT
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 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:601-200-4321
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:286 CALHOUN STATION PKWY
Practice Address - Street 2:
Practice Address - City:GLUCKSTADT
Practice Address - State:MS
Practice Address - Zip Code:39110-5537
Practice Address - Country:US
Practice Address - Phone:601-200-4321
Practice Address - Fax:601-859-0159
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MS33700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program