Provider Demographics
NPI:1457306565
Name:WUNDER, DANIEL J (MD)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:J
Last Name:WUNDER
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 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-851-6033
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:3024 BUSINESS PARK CIR
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-3132
Practice Address - Country:US
Practice Address - Phone:615-851-6033
Practice Address - Fax:615-851-2018
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD221322085R0202X
TN221322085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1509323Medicaid
TN1510976OtherMEDICAID - MTI
TN3083897Medicaid
TN4201196OtherBCBS TN
KY64919632OtherKY MEDICAID
TN3136324OtherBCBS
TN3136322OtherBCBS
TN4291353OtherBCBS - MTI
TN300108664OtherRAILROAD MEDICARE
TN10330I6945Medicare PIN
TNF84776Medicare UPIN
TN1509323Medicaid
TN3849918Medicare PIN
TN30838901Medicare PIN