Provider Demographics
NPI:1205809738
Name:GUNKEL, DIETER KARL (MD)
Entity type:Individual
Prefix:DR
First Name:DIETER
Middle Name:KARL
Last Name:GUNKEL
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 1:11702 MERCY BLVD
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1750
Mailing Address - Country:US
Mailing Address - Phone:912-721-2900
Mailing Address - Fax:912-721-2903
Practice Address - Street 1:11702 MERCY BLVD
Practice Address - Street 2:SUITE 2D
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1750
Practice Address - Country:US
Practice Address - Phone:912-721-2900
Practice Address - Fax:912-721-2903
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014247174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00070859GMedicaid
GA060052360OtherMEDICARE RAILROAD
GAD29637Medicare UPIN
GA06BDFZV01Medicare PIN