Provider Demographics
NPI:1164751954
Name:RICHARD E KUNZ DPM INC
Entity Type:Organization
Organization Name:RICHARD E KUNZ DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:KUNZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:801-466-1333
Mailing Address - Street 1:2178 S 900 E
Mailing Address - Street 2:SUITE #1
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2388
Mailing Address - Country:US
Mailing Address - Phone:801-466-1333
Mailing Address - Fax:801-466-6601
Practice Address - Street 1:2178 S 900 E
Practice Address - Street 2:SUITE #1
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2388
Practice Address - Country:US
Practice Address - Phone:801-466-1333
Practice Address - Fax:801-466-6601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT101599-0501213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT518520920002Medicaid
UT4482150001Medicare NSC
UT518520920002Medicaid
UT000004922Medicare PIN