Provider Demographics
NPI:1750326864
Name:GUNNETT, CAROL A (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:GUNNETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 BOYSON ROAD
Mailing Address - Street 2:BLDG C
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233
Mailing Address - Country:US
Mailing Address - Phone:319-826-6773
Mailing Address - Fax:319-826-6775
Practice Address - Street 1:1350 BOYSON ROAD
Practice Address - Street 2:BLDG C
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233
Practice Address - Country:US
Practice Address - Phone:319-826-6773
Practice Address - Fax:319-826-6775
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA37419207Q00000X
IAR7788207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP01568811OtherRR MEDICARE PROVIDER NUMBER
IA1750326864Medicaid
IAR7788OtherIA RESIDENT LICENSE
IAP01568811OtherRR MEDICARE PROVIDER NUMBER
IA1750326864Medicaid
IA1750326864Medicaid