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

Primary practice address
6000 N Allen Road Peoria IL 61614-3294
Phone: (309) 691-1400
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #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 3 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407857311 NPPES
Illinois MEDICAID 036091210

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