Provider Demographics
NPI:1336362383
Name:GUNDERSEN AND ZUKER PTR
Entity Type:Organization
Organization Name:GUNDERSEN AND ZUKER PTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FURTAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-722-3556
Mailing Address - Street 1:8747 FERRY ST
Mailing Address - Street 2:
Mailing Address - City:MONTAGUE
Mailing Address - State:MI
Mailing Address - Zip Code:49437-2207
Mailing Address - Country:US
Mailing Address - Phone:231-893-5671
Mailing Address - Fax:231-893-7585
Practice Address - Street 1:8747 FERRY ST
Practice Address - Street 2:
Practice Address - City:MONTAGUE
Practice Address - State:MI
Practice Address - Zip Code:49437-2207
Practice Address - Country:US
Practice Address - Phone:231-893-5671
Practice Address - Fax:231-893-7585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1942385265OtherNPI MONTAGUE
1104907153OtherNPI RONALD ZUKER OD
1417993098OtherNPI DAVID GUNDERSEN OD
MI0809120001Medicare NSC