1437263852 NPI number — MR. JOHN ALBERT KUNZE RPH

Table of content: MR. JOHN ALBERT KUNZE RPH (NPI 1437263852)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437263852 NPI number — MR. JOHN ALBERT KUNZE RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUNZE
Provider First Name:
JOHN
Provider Middle Name:
ALBERT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RPH
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:
1437263852
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7540 KLINGSTON ST NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MASSILLON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44646-1037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-833-5658
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4894 ERIE AVE SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAVARRE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44662-9601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-879-5626
Provider Business Practice Location Address Fax Number:
330-879-5666
Provider Enumeration Date:
08/19/2006

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: 183500000X , with the licence number:  03-3-10514 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2472088 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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