Individual
DR. MICHAEL J GUSTAVEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1702 W FAIRVIEW AVE, BOISE, ID 83702-5121
(208) 850-1641
Mailing address
1188 W UNIVERSITY DR, BOISE, ID 83706-3009
(208) 336-8250
(208) 345-9514
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
M8510
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306842182
—
ID
Enumeration date
06/24/2005
Last updated
02/28/2019
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