Provider Demographics
NPI:1801165899
Name:GUNDEN, LAMAR DEAN
Entity type:Individual
Prefix:
First Name:LAMAR
Middle Name:DEAN
Last Name:GUNDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7644 E POPLAR RD
Mailing Address - Street 2:
Mailing Address - City:CLARE
Mailing Address - State:MI
Mailing Address - Zip Code:48617-9784
Mailing Address - Country:US
Mailing Address - Phone:989-386-7808
Mailing Address - Fax:
Practice Address - Street 1:7644 E POPLAR RD
Practice Address - Street 2:
Practice Address - City:CLARE
Practice Address - State:MI
Practice Address - Zip Code:48617-9784
Practice Address - Country:US
Practice Address - Phone:989-386-7808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAF180001485171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor