Healthcare Provider Details

I. General information

NPI: 1649325895
Provider Name (Legal Business Name): ARUN GUNDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1836 S MACARTHUR BLVD
SPRINGFIELD IL
62704-4000
US

IV. Provider business mailing address

2300 N EDWARD ST GSBLL
DECATUR IL
62526-4163
US

V. Phone/Fax

Practice location:
  • Phone: 217-789-1403
  • Fax: 217-789-1825
Mailing address:
  • Phone: 217-876-2857
  • Fax: 217-876-2874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number390200000X
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: