Gibbons, Michael J
Gibbons, Michael J is an individual health care provider with primary practice located at 6000 N Allen Road , Peoria IL 61614-3294. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Sports Medicine. Allopathic & Osteopathic Physicians / Sports Medicine is his primary health care specialty. Gibbons, Michael J can be contacted via phone (309) 691-1400.Contact Information
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Other Service Providers / Specialist | 174400000X | 036091210 | Illinois |
Allopathic & Osteopathic Physicians / Sports Medicine | 207XX0005X | 036091210 | Illinois |
Profile Details
NPI number | 1407857311 |
---|---|
LBN Legal business name | Gibbons, Michael J |
Credentials | Doctor of Medicine (MD) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Aug 2nd, 2005 |
Last updated | Sep 9th, 2021 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1407857311 | NPPES |
Illinois | MEDICAID | 036091210 |
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