Provider Demographics
NPI:1760569958
Name:GUMPEL, XIMENA ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:XIMENA
Middle Name:ELIZABETH
Last Name:GUMPEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RADIATION ONCOLOGY
Mailing Address - Street 2:4005 ORCHARD DRIVE
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48670-0001
Mailing Address - Country:US
Mailing Address - Phone:989-839-3450
Mailing Address - Fax:
Practice Address - Street 1:RADIATION ONCOLOGY
Practice Address - Street 2:4005 ORCHARD DRIVE
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48670-0001
Practice Address - Country:US
Practice Address - Phone:989-839-3450
Practice Address - Fax:989-839-1347
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003014363AM0700X
TXPA04049363A00000X
MI5601005756363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q28715Medicare UPIN
8C7276Medicare PIN