Provider Demographics
NPI:1285636415
Name:GUNTER, MICHAEL A (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:GUNTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 N WABASH
Mailing Address - Street 2:SUITE 370
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-2213
Mailing Address - Country:US
Mailing Address - Phone:765-660-7500
Mailing Address - Fax:765-662-3411
Practice Address - Street 1:330 N WABASH
Practice Address - Street 2:SUITE G20
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-2600
Practice Address - Country:US
Practice Address - Phone:765-660-7600
Practice Address - Fax:765-651-7313
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031244A208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000751512OtherANTHEM
IN100204630AMedicaid
INM400064258Medicare PIN
IN000000751512OtherANTHEM