Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 4301077187 | MI |
NPI | 1104855030 |
---|---|
Provider Name | Gustavo P Morel |
First Address | Carol Stream, IL 60122-4602 |
Second Address | Iron Mountain, MI 49801-3650 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2006 |
Last Update Date | 03/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4301989 | (05) | MI |
H35801 | (02) | MI |