Healthcare Provider Details

I. General information

NPI: 1346322005
Provider Name (Legal Business Name): MICHAEL I GABRILOVICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 OFFICE PARK DR
HAMILTON OH
45013-1496
US

IV. Provider business mailing address

25 OFFICE PARK DR
HAMILTON OH
45013-1496
US

V. Phone/Fax

Practice location:
  • Phone: 513-893-5864
  • Fax: 513-893-5865
Mailing address:
  • Phone: 513-893-5864
  • Fax: 513-893-5865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number35.085432
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number35.085432
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: