Individual
GUSTAVO ALFONSO LAMELA DOMENECH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4660 S HAGADORN RD STE 500, EAST LANSING, MI 48823-6804
(517) 884-8701
(517) 884-8787
Mailing address
804 SERVICE RD STE A109B, EAST LANSING, MI 48824-7015
(517) 353-4911
(517) 432-3928
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
24112
PR
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
24112
PR
390200000X
Student in an Organized Health Care Education/Training Program
—
PR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/19/2018
Last updated
11/24/2025
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