Provider Demographics
NPI:1114948544
Name:GUNZEL, DAVID A (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:GUNZEL
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 1:1201 PINE ST
Mailing Address - Street 2:
Mailing Address - City:ELDORADO
Mailing Address - State:IL
Mailing Address - Zip Code:62930-1634
Mailing Address - Country:US
Mailing Address - Phone:618-297-9665
Mailing Address - Fax:618-297-9638
Practice Address - Street 1:1201 PINE ST
Practice Address - Street 2:
Practice Address - City:ELDORADO
Practice Address - State:IL
Practice Address - Zip Code:62930-1634
Practice Address - Country:US
Practice Address - Phone:618-297-9665
Practice Address - Fax:618-297-9638
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004187213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL480014099OtherRR MEDICARE
IL0718600001Medicare NSC
IL480014099OtherRR MEDICARE
IL505620Medicare PIN
IL327011Medicare ID - Type Unspecified