Provider Demographics
NPI:1265488290
Name:KUNZER, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:KUNZER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7910 E WASHINGTON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-6803
Practice Address - Country:US
Practice Address - Phone:317-355-7171
Practice Address - Fax:317-355-9022
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058249A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01678714OtherRR MEDICARE
IN200481430Medicaid
INI16210Medicare UPIN
INP01678714OtherRR MEDICARE
IN266180652Medicare PIN
IN715530Y1Medicare PIN