Healthcare Provider Details

I. General information

NPI: 1013694207
Provider Name (Legal Business Name): GUSTAVO ANDRES MONTEROS PROANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WELLNESS WAY
MILFORD DE
19963-4364
US

IV. Provider business mailing address

29643 VINCENT VILLAGE DR
MILTON DE
19968-3803
US

V. Phone/Fax

Practice location:
  • Phone: 302-612-3915
  • Fax:
Mailing address:
  • Phone: 347-479-5750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC1-0028795
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: