Michael J Gustavel


Address: 1702 W Fairview Ave, Boise, ID 83702-5121
Phone: 2089577400

Michael J Gustavel (NPI# 1306842182, PAC ID# 6901794148) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is ORTHOPEDIC SURGERY.

Physician Overview

Nation Provider ID (NPI) 1306842182
PAC ID by PECOS 6901794148
Professional Enrollment ID I20190416001059
Full Name Michael J Gustavel
Address 1702 W Fairview Ave
Boise
ID 83702-5121
Phone Number 2089577400
Gender M
Credential MD
Medical School UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE
Graduation Year 1998
Primary Specialty ORTHOPEDIC SURGERY
Secondary Specialties SPORTS MEDICINE
Accepts Medicare Assignment Y

Claims Based Hospital Affiliation

Claim Control Number (CCN) Legal Business Name
130063 TREASURE VALLEY HOSPITAL
130006 ST LUKE'S REGIONAL MEDICAL CENTER

Other Locations

Address Phone Organization
1702 W Fairview Ave, Boise, ID 83702-5121 2089577400

Organization Information

Office Location

Street Address 1702 W FAIRVIEW AVE
City BOISE
State ID
Zip 83702-5121

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Competitor

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City BOISE
Zip Code 83702
Specialty ORTHOPEDIC SURGERY
City + Specialty BOISE + ORTHOPEDIC SURGERY

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS)
Jurisdiction Medicare

This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.

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