Vonderlancken, Gustavo
Vonderlancken, Gustavo is an individual health care provider with primary practice located at 2044 Madison Ave Suite 27, Granite City IL 62040-4641. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Vonderlancken, Gustavo can be contacted via phone (618) 451-7600.Contact Information
Primary practice address
2044 Madison Ave Suite 27
Granite City IL 62040-4641
Phone: (618) 451-7600
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 036109409 | Illinois |
Profile Details
| NPI number | 1881683282 |
|---|---|
| LBN Legal business name | Vonderlancken, Gustavo |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 18th, 2005 |
| Last updated | Dec 19th, 2013 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1881683282 | NPPES |
| Illinois | MEDICAID | 036109409 |
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