Provider Demographics
NPI:1366550022
Name:GUNDERSON, STEVEN K (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:K
Last Name:GUNDERSON
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 1:600 WILSON CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025-2751
Mailing Address - Country:US
Mailing Address - Phone:812-532-2700
Mailing Address - Fax:812-537-1507
Practice Address - Street 1:600 WILSON CREEK RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-2751
Practice Address - Country:US
Practice Address - Phone:812-532-2700
Practice Address - Fax:812-537-1507
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036215A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00215314Medicaid
000000111488OtherANTHEM
000000111488OtherANTHEM
940340FMedicare ID - Type Unspecified