MEDICARE: DR. ROBERT D GUNNINK DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	4248	AZ

General Provider Information

NPI Number	:	1144293028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT D GUNNINK DO

Provider Business Mailing Address
First Line	:	187 BALLARDVALE ST
Second Line	:	SUITE 202
City	:	WILMINGTON
State	:	MA
Zip	:	01887-1082
Country	:	US
Telephone Number	:	978-774-7243
Fax Number	:	978-774-7421

Provider Business Practice Location Address
First Line	:	215 S POWER RD
Second Line	:	SUITE 205
City	:	MESA
State	:	AZ
Zip	:	85206-5235
Country	:	US
Telephone Number	:	480-991-0480
Fax Number	:	480-991-0478

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	01/17/2012

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