Healthcare Provider Details

I. General information

NPI: 1023178159
Provider Name (Legal Business Name): MICHAEL SCOTT GELBART MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 N DIXIE HWY
TROY OH
45373-1337
US

IV. Provider business mailing address

2591 MIAMISBURG CENTERVILLE RD SUITE 302
DAYTON OH
45459-3706
US

V. Phone/Fax

Practice location:
  • Phone: 937-440-4892
  • Fax: 937-440-4381
Mailing address:
  • Phone: 937-433-7622
  • Fax: 937-433-7656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2001004973
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number36116990
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35093872
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: