1568569333 NPI number — STEVEN GUNZLER MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568569333 NPI number — STEVEN GUNZLER MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

GUNZLER

Provider First Name:

STEVEN

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1568569333

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/03/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

24701 EUCLID AVE

Provider Second Line Business Mailing Address:

3RD FLOOR

Provider Business Mailing Address City Name:

EUCLID

Provider Business Mailing Address State Name:

OH

Provider Business Mailing Address Postal Code:

44117-1714

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

1611 S GREEN RD STE 204

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SOUTH EUCLID

Provider Business Practice Location Address State Name:

OH

Provider Business Practice Location Address Postal Code:

44121-4123

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

216-844-8685

Provider Business Practice Location Address Fax Number:

216-844-5613

Provider Enumeration Date:

09/20/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207T00000X , with the licence number:  35.090685 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2084N0400X , with the licence number: MD25171 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2084N0400X , with the licence number: 35.090685 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 2786990 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
• Identifier: 752543 . This is a "BUCKEYE MEDICAID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 421796 . This is a "WELLCARE MEDICAID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 000000541320 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 269651 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
• Identifier: P00428930 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 000000229392 . This is a "UNISON" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 7178687 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".