Provider Demographics
NPI:1427271477
Name:GUNDERSEN AND ZUKER PTR
Entity type:Organization
Organization Name:GUNDERSEN AND ZUKER PTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FURTAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-722-3556
Mailing Address - Street 1:24 S MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:MI
Mailing Address - Zip Code:49455-1240
Mailing Address - Country:US
Mailing Address - Phone:231-861-5417
Mailing Address - Fax:231-861-6655
Practice Address - Street 1:24 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:MI
Practice Address - Zip Code:49455-1240
Practice Address - Country:US
Practice Address - Phone:231-861-5417
Practice Address - Fax:231-861-6655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1417993098OtherNPI DAVID GUNDERSEN OD
1033294350OtherNPI SHELBY
1104907153OtherNPI RONALD ZUKER OD
1417993098OtherNPI DAVID GUNDERSEN OD