Individual
MICHAEL T GIBBONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1296 TOD PL NW, SUITE 200, WARREN, OH 44485-2474
(330) 656-5911
(330) 656-5901
Mailing address
5700 DARROW RD, SUITE 106, HUDSON, OH 44236-5026
(330) 656-5911
(330) 656-5901
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
35-090557
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000028430
ANTHEM
OH
01
—
000000381140
ANTHEM
OH
01
—
000000385524
ANTHEM
OH
05
—
2811318
—
OH
Enumeration date
10/18/2007
Last updated
06/12/2008
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