Provider Demographics
NPI:1376625533
Name:GILBERT NEUROLOGICAL ASSOC PLLC
Entity type:Organization
Organization Name:GILBERT NEUROLOGICAL ASSOC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-552-3734
Mailing Address - Street 1:18535 W 12 MILE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2676
Mailing Address - Country:US
Mailing Address - Phone:248-552-3734
Mailing Address - Fax:248-552-3736
Practice Address - Street 1:18535 W 12 MILE RD
Practice Address - Street 2:SUITE A
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-2676
Practice Address - Country:US
Practice Address - Phone:248-552-3734
Practice Address - Fax:248-552-3736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010725322084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1106303932OtherBCBS
MI1106303932OtherBLUE CARE NETWORK
MI130F338870OtherBC/BS
MI12440OtherCAPE HEALTH PLAN
MI4717514Medicaid
MIH89219OtherHAP
MI130F338870OtherBCN
MI146353OtherGREAT LAKES HEALTH PLAN
MI12440OtherCAPE HEALTH PLAN
MI130F338870OtherBC/BS