Provider Demographics
NPI:1306595806
Name:GUNDERMAN, LUKE DANIEL
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:DANIEL
Last Name:GUNDERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 W WALNUT ST # R2E201
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5188
Mailing Address - Country:US
Mailing Address - Phone:317-278-6061
Mailing Address - Fax:317-274-8575
Practice Address - Street 1:950 W WALNUT ST # R2E201
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5188
Practice Address - Country:US
Practice Address - Phone:317-278-6061
Practice Address - Fax:317-274-8575
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN11022117A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program