Healthcare Provider Details

I. General information

NPI: 1326648577
Provider Name (Legal Business Name): WILLIAM ROBERT MUNDLE MD FRCSC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 JOHN ST STE N1100
KALAMAZOO MI
49007-5349
US

IV. Provider business mailing address

181 ESSEX ROAD
TECUMSEH ONTARIO
N8N2K5
CA

V. Phone/Fax

Practice location:
  • Phone: 269-341-7887
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number35.140021
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number4301504408
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: