Individual
GARY S GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
44378 DEQUINDRE RD, STERLING HEIGHTS, STERLING HEIGHTS, MI 48314-1003
(248) 964-3070
(248) 964-0057
Mailing address
44378 DEQUINDRE RD, STERLING HEIGHTS, STERLING HEIGHTS, MI 48314-1003
(248) 964-3070
(248) 964-0057
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
4301046424
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2588472
—
MI
01
—
320F362430
BCBSM
MI
Enumeration date
03/24/2006
Last updated
02/12/2015
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