Healthcare Provider Details

I. General information

NPI: 1245219427
Provider Name (Legal Business Name): MICHAEL EDWARD GIFFORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 DELCO PARK DR
DAYTON OH
45420-1391
US

IV. Provider business mailing address

PO BOX 932759
CLEVELAND OH
44193-0015
US

V. Phone/Fax

Practice location:
  • Phone: 937-293-8228
  • Fax: 937-293-8229
Mailing address:
  • Phone: 937-293-8228
  • Fax: 937-293-8229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35086202
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: