Provider Demographics
NPI:1114915824
Name:KUNHARDT, RENE E (MD)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:E
Last Name:KUNHARDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 LITTLE RD
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4421
Mailing Address - Country:US
Mailing Address - Phone:727-842-9486
Mailing Address - Fax:727-849-2623
Practice Address - Street 1:2035 LITTLE RD
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-4421
Practice Address - Country:US
Practice Address - Phone:727-842-9486
Practice Address - Fax:727-849-2623
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79231207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258746700Medicaid
27664OtherBLUE CROSS BLUE SHIELD
6506906001OtherCIGNA
2500783OtherUNITED HEALTH CARE
2323689OtherAETNA
270610OtherAVMED
6506906001OtherCIGNA
35259XMedicare ID - Type Unspecified