Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 4301086233 | MI |
NPI | 1013124312 |
---|---|
Provider Name | Gustavo Cumbo-Nacheli |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49546-8292 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 24/02/2021 |