Male or Other

Dr. Mark R. Gundersen MD

Family Medicine Physician in Fergus Falls, MN(View on Map)

Full Name

Dr. Mark R Gundersen MD

NPI Number

1952390106

NPI Type

Individual Provider

Gender

Male

Enumeration Date

10/20/2005

Specialties

(Taxonomies)

Code

207Q00000X

Primary Taxonomy

Yes

Licenses

State

Michigan
Minnesota

License Number

4301069187
35677

Contact
Information

Purpose

Mailing
Location

Address

1216 RYANS RD
712 SOUTH CASCADE STREET

City

Worthington
Fergus Falls

State

MN
MN

Postal Code

56187-1722
56537-2813

Country

US
US

Telephone Number

(507) 372-2921
(218) 736-8000

Identifiers

Identifier

080093188
4540600
5659321
010G56026
0802502771
080D410020
204375
F31478
204375
Unknown
Unknown
Unknown
Unknown

Identifier State

MI
MI
MI
MI
MI
MI
MI
MI
MI
Unknown
Unknown
Unknown
Unknown

Identifier Issuer

METRAHEALTH
Unknown
AETNA
HEALTH PLUS
BLUE CROSS BLUE SHIELD
BLUE CROSS BLUE SHIELD
MCLAREN HEALTH PLAN
HEALTH NET FEDERAL
HEALTH ADVANTAGE NETWORK
Unknown
Unknown
Unknown
Unknown

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 10/29/2019

Provider Address

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Michael Vanvalkenburg MD

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David Ellison MD

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Specialties: Family Medicine Physician (Primary)Emergency Medicine Physician

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