1619117611 NPI number — MR. DAVID MICHAEL KUNTZ LPC

Table of content: MR. DAVID MICHAEL KUNTZ LPC (NPI 1619117611)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619117611 NPI number — MR. DAVID MICHAEL KUNTZ LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUNTZ
Provider First Name:
DAVID
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619117611
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
109 ANGELIQUE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WABASHA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55981-1750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-565-3334
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
602 11TH AVE NW
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55901-2291
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-292-1379
Provider Business Practice Location Address Fax Number:
507-289-4524
Provider Enumeration Date:
03/03/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LPC00660 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)