Provider Demographics
NPI:1538381421
Name:UNZICKER, GWENDOLYN RUTH (MD)
Entity type:Individual
Prefix:DR
First Name:GWENDOLYN
Middle Name:RUTH
Last Name:UNZICKER
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Gender:F
Credentials:MD
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Mailing Address - Street 1:25 MICHIGAN ST NE
Mailing Address - Street 2:SUITE 5100
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2515
Mailing Address - Country:US
Mailing Address - Phone:616-267-0800
Mailing Address - Fax:616-267-0801
Practice Address - Street 1:25 MICHIGAN ST NE
Practice Address - Street 2:SUITE 5100
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2515
Practice Address - Country:US
Practice Address - Phone:616-267-0800
Practice Address - Fax:616-267-0801
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2012-01-03
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Provider Licenses
StateLicense IDTaxonomies
MI4301086304207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine