MEDICARE: MITCHELL S GIBBONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	R-11831	IA
2	207R00000X	Internal Medicine Physician	R-11831	IA
3	207N00000X	Dermatology Physician	04-48713	KS

General Provider Information

NPI Number	:	1871116210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL S GIBBONS

Provider Business Mailing Address
First Line	:	200 HAWKINS DR
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52242-1009
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7520 W 160TH ST STE 100
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66085-8137
Country	:	US
Telephone Number	:	913-871-8221
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2020
Last Update Date	:	06/24/2024

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Directions to “ MITCHELL S GIBBONS ” Practice Location

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