Provider Demographics
NPI:1114922754
Name:KUNDEL, RAY L (MD)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:L
Last Name:KUNDEL
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 1:1000 E 1ST ST
Mailing Address - Street 2:STE 204
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2297
Mailing Address - Country:US
Mailing Address - Phone:218-722-1408
Mailing Address - Fax:218-722-3055
Practice Address - Street 1:1000 E 1ST ST
Practice Address - Street 2:STE 204
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2297
Practice Address - Country:US
Practice Address - Phone:218-722-1408
Practice Address - Fax:218-722-3055
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2012-08-28
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
MN22787208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN885285500Medicaid
MN885285500Medicaid