Provider Demographics
NPI:1790570604
Name:GILBERT, IAN WALTON (DO, MS)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:WALTON
Last Name:GILBERT
Suffix:
Gender:M
Credentials:DO, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:275 MICHIGAN ST NE STE 3003
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2531
Mailing Address - Country:US
Mailing Address - Phone:616-391-8810
Mailing Address - Fax:616-391-8897
Practice Address - Street 1:275 MICHIGAN ST NE STE 3003
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2531
Practice Address - Country:US
Practice Address - Phone:616-391-8810
Practice Address - Fax:616-391-8897
Is Sole Proprietor?:No
Enumeration Date:2025-04-11
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5151017452208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics