Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 4301036565 | MI |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 4301036565 | MI |
NPI | 1225066079 |
---|---|
Provider Name | Dr. Robert Gunnell |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grant, MI 49327-9006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 05/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B44869 | (02) |