Provider Demographics
NPI:1598787491
Name:MICAMES, CARLOS GUSTAVO (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:GUSTAVO
Last Name:MICAMES
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:PO BOX 1121
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-1121
Mailing Address - Country:US
Mailing Address - Phone:787-414-9902
Mailing Address - Fax:
Practice Address - Street 1:55 CALLE DR BASORA N
Practice Address - Street 2:EDIFICIO MEDICO IV, OFICINA 1-K
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4810
Practice Address - Country:US
Practice Address - Phone:787-833-4865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2003-00666207RG0100X
PR16768207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5904493Medicaid
BM9760073OtherDEA
NCI60614Medicare UPIN
NC20559983Medicare ID - Type Unspecified