Basic Information
| Provider Information | |||||||||
| NPI: | 1972711851 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUNDR | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | ALBERT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 716 ADAIR AVE | ||||||||
| Address2: | |||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437012836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7408919000 | ||||||||
| FaxNumber: | 7408919001 | ||||||||
| Practice Location | |||||||||
| Address1: | 1330 CLARK ST | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437259614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404219530 | ||||||||
| FaxNumber: | 7404219531 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 01/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | ME107505 | FL | N | Allopathic & Osteopathic Physicians | General Practice | 208D00000X | 35.130085 | OH | N | Allopathic & Osteopathic Physicians | General Practice | 207RG0300X | 35.130085 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0206366 | 05 | OH | MEDICAID |