Provider Demographics
NPI:1447398623
Name:GURULE, MICHAEL E (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:E
Last Name:GURULE
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 1:711 CHRISTOPHER DR
Mailing Address - Street 2:
Mailing Address - City:BELEN
Mailing Address - State:NM
Mailing Address - Zip Code:87002-2617
Mailing Address - Country:US
Mailing Address - Phone:505-248-1800
Mailing Address - Fax:505-248-1917
Practice Address - Street 1:711 CHRISTOPHER DR
Practice Address - Street 2:
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002-2617
Practice Address - Country:US
Practice Address - Phone:505-248-1800
Practice Address - Fax:505-248-1917
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM92-68207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME6848Medicaid
NME6848Medicaid