Provider Demographics
NPI:1831270891
Name:GUNDERSEN AND ZUKER PLLC
Entity type:Organization
Organization Name:GUNDERSEN AND ZUKER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING 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 1:442 W WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49440-1110
Mailing Address - Country:US
Mailing Address - Phone:231-722-3556
Mailing Address - Fax:231-726-6334
Practice Address - Street 1:442 W WESTERN AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49440-1110
Practice Address - Country:US
Practice Address - Phone:231-722-3556
Practice Address - Fax:231-726-6334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002694152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI410012883OtherRAILROAD MEDICARE
MI5082466Medicaid
1417993098OtherNPI DAVID GUNDERSEN OD
MI5082457Medicaid
1104907153OtherNPI RONALD ZUKER OD
U28849Medicare UPIN
MICE4209Medicare PIN
MI410012883OtherRAILROAD MEDICARE
1104907153OtherNPI RONALD ZUKER OD
T33315Medicare UPIN