Provider Demographics
NPI:1801867676
Name:GUNADI, IRWAN K (MD)
Entity Type:Individual
Prefix:
First Name:IRWAN
Middle Name:K
Last Name:GUNADI
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:612 NOLANA ST
Mailing Address - Street 2:STE 330
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3026
Mailing Address - Country:US
Mailing Address - Phone:956-630-2225
Mailing Address - Fax:956-630-2275
Practice Address - Street 1:612 NOLANA ST
Practice Address - Street 2:STE 330
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3026
Practice Address - Country:US
Practice Address - Phone:956-630-2225
Practice Address - Fax:956-630-2275
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF40332085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD77874Medicare UPIN
TX00975TMedicare ID - Type Unspecified