Provider Demographics
NPI:1053314278
Name:KUNS, BRETT ROGER (DO)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:ROGER
Last Name:KUNS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1031 PIERCE ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-4669
Mailing Address - Country:US
Mailing Address - Phone:419-557-5568
Mailing Address - Fax:419-557-5542
Practice Address - Street 1:101 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CASTALIA
Practice Address - State:OH
Practice Address - Zip Code:44824-9262
Practice Address - Country:US
Practice Address - Phone:419-684-5369
Practice Address - Fax:419-684-7238
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004347207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0704410Medicaid
OH000000134864OtherANTHEM BLUE CROSS BLUE SH
OH080026370OtherRAIL ROAD MEDICARE
OH0613644Medicare PIN
OH000000134864OtherANTHEM BLUE CROSS BLUE SH