Individual
GUSTAVO VONDERLANCKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2044 MADISON AVE, SUITE 27, GRANITE CITY, IL 62040-4641
(618) 451-7600
Mailing address
2044 MADISON AVE, SUITE 27, GRANITE CITY, IL 62040-4641
(618) 451-7600
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036109409
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036109409
—
IL
Enumeration date
10/18/2005
Last updated
12/19/2013
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