1760467658 NPI number — RICHARD L KUNIG D.P.M

Table of content: RICHARD L KUNIG D.P.M (NPI 1760467658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760467658 NPI number — RICHARD L KUNIG D.P.M

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUNIG
Provider First Name:
RICHARD
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.M
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:
1760467658
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2660 W MARKET ST STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRLAWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44333-4209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-926-3231
Provider Business Mailing Address Fax Number:
330-255-5080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2660 W MARKET ST STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRLAWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44333-4209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-926-3231
Provider Business Practice Location Address Fax Number:
330-255-5080
Provider Enumeration Date:
12/13/2005

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: 213ES0131X , with the licence number:  36003261 , 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: 2585555 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".