Individual
MR. KARL RAYMOND GUNDERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2120 MADISON AVE, STE 405, GRANITE CITY, IL 62040
(618) 876-0653
(618) 876-0654
Mailing address
2120 MADISON AVE, STE 405, GRANITE CITY, IL 62040
(618) 876-0653
(618) 876-0654
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036105102
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036105102
—
IL
01
—
205739907
MEDICAID
MO
Enumeration date
09/01/2006
Last updated
08/14/2012
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