Provider Demographics
NPI:1730258252
Name:GUNNELLS, MICHELE (DO)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:GUNNELLS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 NEWBURYPORT RD
Mailing Address - Street 2:
Mailing Address - City:UPPER HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:19053-1556
Mailing Address - Country:US
Mailing Address - Phone:215-860-4110
Mailing Address - Fax:267-295-8208
Practice Address - Street 1:12 NEWBURYPORT RD
Practice Address - Street 2:
Practice Address - City:UPPER HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:19053
Practice Address - Country:US
Practice Address - Phone:215-860-4110
Practice Address - Fax:267-295-8208
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05006203L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E65195Medicare UPIN
PA611502FWJMedicare PIN