Provider Demographics
NPI:1336172006
Name:GUDMUNDSSON, GUDMUNDUR STEINAR (MD)
Entity Type:Individual
Prefix:DR
First Name:GUDMUNDUR
Middle Name:STEINAR
Last Name:GUDMUNDSSON
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 1:2040 OGDEN AVE 313
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7205
Mailing Address - Country:US
Mailing Address - Phone:630-692-5208
Mailing Address - Fax:630-499-2399
Practice Address - Street 1:2088 OGDEN AVE
Practice Address - Street 2:STE. 160
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-4376
Practice Address - Country:US
Practice Address - Phone:630-851-6440
Practice Address - Fax:630-851-7001
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36100340207RC0000X, 207UN0901X, 2085B0100X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL97799Medicare PIN
IL101 15504OtherB/C B/S OF IL
ILIL1959004Medicare PIN
GACB0709/060071136OtherRR MEDICARE GROUP #/PIN
ILG64072Medicare UPIN
IL036100340 1Medicaid