| Doctor Name: | DR. RONNIE MICHAEL GUNDLACH |
| NPI Number: | 1093700957 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O. |
| License Number: | 0102201658 |
| Business Practice Address: | Nas Jrb Willow Grove Branch Health Clinic Willow Grove, PA - 19090 |
| Business Phone Number: | 2154436360 |
| Business Fax Number: | 2157732411 |
| Mailing Address: | Nas Jrb Willow Grove, Branch Health Clinic WILLOW GROVE |
| State: | PA |
| Postal Code: | 19090 |
| Phone Number: | 2154436360 |
| Fax Number: | 2157732411 |
| NPI Enumeration Date: | 09/16/2005 |
| NPI Last Update Date: | 10/22/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 0102201658 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |