Individual provider Active NPI

Evan Gibson, MD

  • Emergency Medicine Physician
  • Milwaukee, WI
National Provider Identifier
1124721329
Registry record updated Aug 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
84453-20 Issued in WI
Practice address
8701 Watertown Plank Rd
Milwaukee, WI 53226-3548
Phone
(414) 955-6450
NPI assigned
Mar 24, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 84453-20 WI Primary

Addresses

Primary practice location

8701 Watertown Plank Rd
Milwaukee, WI 53226-3548

Mailing address

252 McHenry St
Burlington, WI 53105-1828

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230921000980 WI Order and Referring Only - Emergency MedicinePractitioner - Emergency Medicine 8628422805

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Medical College of Wisconsin, 2023
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

10000 Innovation Dr
Milwaukee, WI 53226-4837

PO Box
Chicago, IL 60673

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1679616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785628800000",
    "number": "1124721329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "252 MCHENRY ST",
            "city": "BURLINGTON",
            "state": "WI",
            "postal_code": "531051828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8701 WATERTOWN PLANK RD",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532263548",
            "telephone_number": "414-955-6450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "EVAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-24",
        "last_updated": "2026-08-02",
        "certification_date": "2026-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "84453-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.