MEDICARE: JEFFREY GUNZENHAUSER MD

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	2085R0202X	Diagnostic Radiology Physician	184898	NY
2	2085R0204X	Vascular & Interventional Radiology Physician	184898	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GU039853	OTHER	PA	MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205829181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY GUNZENHAUSER MD

Provider Business Mailing Address
First Line	:	PO BOX 32
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60065-0032
Country	:	US
Telephone Number	:	847-593-8460
Fax Number	:	847-919-4615

Provider Business Practice Location Address
First Line	:	2444 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-4415
Country	:	US
Telephone Number	:	570-888-5858
Fax Number	:

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

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	10/22/2018

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