Provider Demographics
NPI:1063550606
Name:GUNSBERG, DAVID WESLEY (DPM)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WESLEY
Last Name:GUNSBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:G3380 BEECHER RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3647
Mailing Address - Country:US
Mailing Address - Phone:810-733-3338
Mailing Address - Fax:810-733-7657
Practice Address - Street 1:G3380 BEECHER RD
Practice Address - Street 2:SUITE A
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3647
Practice Address - Country:US
Practice Address - Phone:810-733-3338
Practice Address - Fax:810-733-7657
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000586213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0992830OtherHEALTH PLUS OF MICHIGAN
T33957Medicare UPIN
5255302Medicare ID - Type Unspecified