Basic Information
| Provider Information | |||||||||
| NPI: | 1457396707 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GILBERT | ||||||||
| FirstName: | SIDNEY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 N SHADELAND AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462194959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3179624836 | ||||||||
| FaxNumber: | 3179628646 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 TOWN CENTER DRIVE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | MOORESVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178345317 | ||||||||
| FaxNumber: | 3178344221 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2006 | ||||||||
| LastUpdateDate: | 10/23/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 01041442 | IN | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.