Provider Demographics
NPI:1376505594
Name:KUNZE, WILFRIED (MD)
Entity Type:Individual
Prefix:
First Name:WILFRIED
Middle Name:
Last Name:KUNZE
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 1:1445 PORTLAND AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3036
Mailing Address - Country:US
Mailing Address - Phone:585-266-1180
Mailing Address - Fax:585-266-4187
Practice Address - Street 1:1445 PORTLAND AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3036
Practice Address - Country:US
Practice Address - Phone:585-266-1180
Practice Address - Fax:585-266-4187
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101393-1207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP010101393OtherBLUE CHOICE OF ROCHESTER
NYP102131OtherPREFERRED CARE
NY00448940Medicaid
NY3893OtherEXCELLUS BCBS OF ROCHESTE
NY13893BMedicare PIN
NYP010101393OtherBLUE CHOICE OF ROCHESTER