| Doctor Name: | MARC GUNDERSON |
| NPI Number: | 1194067561 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 62813-20 |
| Business Practice Address: | 1155 N Mayfair Rd Mcw Department Of Psychiatry Milwaukee, WI - 532263462 |
| Business Phone Number: | 4149558900 |
| Business Fax Number: | |
| Mailing Address: | 1155 N Mayfair Rd, Mcw Department Of Psychiatry MILWAUKEE |
| State: | WI |
| Postal Code: | 532263462 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 03/22/2013 |
| NPI Last Update Date: | 01/28/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 62813-20 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |