Provider Demographics
NPI:1548314859
Name:MORELL, LUIS IVAN (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:IVAN
Last Name:MORELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 486
Mailing Address - Street 2:100 GRAND BLVD PASEOS
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-0486
Mailing Address - Country:US
Mailing Address - Phone:787-850-8217
Mailing Address - Fax:787-850-8217
Practice Address - Street 1:STREET 355 FORMALTELO AVE.
Practice Address - Street 2:SUITE 402
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00792
Practice Address - Country:US
Practice Address - Phone:787-850-8217
Practice Address - Fax:787-850-8217
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR13230208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI10924Medicare UPIN
PR20484MOMedicare ID - Type Unspecified