Basic Information
| Provider Information | |||||||||
| NPI: | 1386646685 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GBUR | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 N SUMMIT ST FL 7 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436041531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197947700 | ||||||||
| FaxNumber: | 4197947715 | ||||||||
| Practice Location | |||||||||
| Address1: | 5705 MONCLOVA RD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | MAUMEE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435371875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197947700 | ||||||||
| FaxNumber: | 4197947715 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2005 | ||||||||
| LastUpdateDate: | 10/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 35059568G | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 4980009 | 05 | MI | MEDICAID | 01716 | 01 | OH | PARAMOUNT | OTHER | 4502161 | 01 | OH | AETNA | OTHER | 4980027 | 05 | MI | MEDICAID | 611448753028 | 01 | OH | CARESOURCE | OTHER | 000000476153 | 01 | OH | ANTHEM | OTHER | 0671705 | 05 | OH | MEDICAID | 4980018 | 05 | MI | MEDICAID | P00431214 | 01 | RRMC | OTHER |