Organization
GRANITE CITY PSYCHIATRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KARL GUNDERSEN MD (MEMBER)
(618) 876-0653
Entity
Organization
Contact information
Practice address
2120 MADISON AVE, SUITE 405, GRANITE CITY, IL 62040-4744
(618) 876-0653
Mailing address
2120 MADISON AVE, SUITE 405, GRANITE CITY, IL 62040-4744
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
036105102
IL
Other
Enumeration date
10/02/2012
Last updated
10/02/2012
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