Healthcare Provider Details

I. General information

NPI: 1669593604
Provider Name (Legal Business Name): KATHLEEN PATRICIA BERNICE GIBBS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 W TECH RD STE 120
MIAMISBURG OH
45342-0956
US

IV. Provider business mailing address

PO BOX 933432
CLEVELAND OH
44193-0039
US

V. Phone/Fax

Practice location:
  • Phone: 937-748-6116
  • Fax: 937-291-6956
Mailing address:
  • Phone: 937-641-3555
  • Fax: 937-641-4528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35088699
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: