Individual
MR. MICHAEL W GUND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1808 W MAIN ST, RUSSELLVILLE, AR 72801-2724
(479) 968-2841
Mailing address
PO BOX 1351, RUSSELLVILLE, AR 72811-1351
(800) 235-1415
(913) 234-1108
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
C00865
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125162701
—
AR
01
—
430024065
RR MEDICARE GROUP CC5970
—
01
—
5S503
BLUE CROSS BLUE SHIELD AR
AR
Enumeration date
08/02/2005
Last updated
11/19/2009
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