Provider Demographics
NPI:1659593754
Name:GUENTERBERG, KRISTAN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTAN
Middle Name:DAVID
Last Name:GUENTERBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9927 MICKELBERRY RD NW
Mailing Address - Street 2:SUITE 121
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9195
Mailing Address - Country:US
Mailing Address - Phone:360-613-1335
Mailing Address - Fax:360-613-1329
Practice Address - Street 1:9927 MICKELBERRY RD NW
Practice Address - Street 2:SUITE 121
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9195
Practice Address - Country:US
Practice Address - Phone:360-613-1335
Practice Address - Fax:360-613-1329
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH57-010164208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery