Individual
KENNETH GORDON GILBERT JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3202 B LAKESHORE DR, CHAMPAIGN, IL 61822-5208
(217) 356-4191
(877) 350-5447
Mailing address
3202 B LAKESHORE DR, CHAMPAIGN, IL 61822-5208
(217) 356-4191
(877) 350-5447
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036050367
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036050367
—
IL
Enumeration date
12/15/2006
Last updated
01/02/2019
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