Provider Demographics
NPI:1104855030
Name:MOREL, GUSTAVO P (MD)
Entity Type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:P
Last Name:MOREL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4602 DEPT
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-4602
Mailing Address - Country:US
Mailing Address - Phone:906-225-4606
Mailing Address - Fax:906-225-4537
Practice Address - Street 1:1711 S STEPHENSON AVE STE 315
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3650
Practice Address - Country:US
Practice Address - Phone:906-774-6257
Practice Address - Fax:906-774-6390
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301077187207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301989Medicaid
MI4301989Medicaid
MIH35801Medicare UPIN