Provider Demographics
NPI:1053371658
Name:GILBERT, NEIL (MD)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:
Last Name:GILBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NEIL
Other - Middle Name:
Other - Last Name:GILBERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
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
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010725322084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH89219OtherHAP
MI1106303932OtherBCBS
MI1106303932OtherBLUE CARE NETWORK
MI130F338870OtherBC/BS
MI146353OtherGREAT LAKES HRALTH PLAN
MI4717514Medicaid
MI12440OtherCAPE HEALTH PLAN
MI130F338870OtherBCN
MIH89219OtherHAP
MI4717514Medicaid