Provider Demographics
NPI:1063472405
Name:GUCCI, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:GUCCI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 STANLEY LN
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-1126
Mailing Address - Country:US
Mailing Address - Phone:313-670-6372
Mailing Address - Fax:
Practice Address - Street 1:2655 WARRENVILLE RD STE 500
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-5646
Practice Address - Country:US
Practice Address - Phone:855-783-6877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-118646207P00000X, 207Q00000X
IA35460207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036118646OtherBLUE SHIELD
P00198373OtherRAILROAD MEDICARE
IL0361186461Medicaid
IA1444240Medicaid
24318OtherMIDLANDS CHOICE
38204OtherWELLMARK BCBS OF IOWA
ILP00941443OtherRRMCARE THRU CESII/GES
24318OtherMIDLANDS CHOICE
I14632Medicare PIN
ILP00941443OtherRRMCARE THRU CESII/GES
24318OtherMIDLANDS CHOICE
ILIL5306010Medicare PIN