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General NPI Number Information
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NPI Number | 1326648577
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Entity Type | Individual
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Provider Name | WILLIAM ROBERT MUNDLE MD FRCSC
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Gender | Male
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Dates
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Enumeration Date | 10/27/2020
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Last Update Date | 03/31/2022
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Provider Practice Location Address
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Address Line | 601 JOHN ST STE N1100
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City | KALAMAZOO
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State | MI
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Zip | 49007-5349
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Country | US
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Telephone | 269-341-7887
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Fax |
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Provider Business Mailing Address
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Address Line | 181 ESSEX ROAD
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City | TECUMSEH
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State | ONTARIO
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Zip | N8N2K5
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Country | CA
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | 35.140021
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | 4301504408
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License Number State | MI
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