Provider Demographics
NPI:1396868337
Name:KADUNCE, DONALD P (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:P
Last Name:KADUNCE
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 1:9393 N 90TH ST
Mailing Address - Street 2:SUITE 102 PMB 337
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5040
Mailing Address - Country:US
Mailing Address - Phone:602-692-2243
Mailing Address - Fax:
Practice Address - Street 1:735 LITTLE DR
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86406-8308
Practice Address - Country:US
Practice Address - Phone:602-692-2243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0028521207ND0900X
ALMD.27538207ND0900X
AZ26802207ND0900X, 207ND0101X, 207NS0135X, 207NI0002X
FLME86716207ND0900X
SC19249207ND0900X, 207NS0135X
UT173614-1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD87731Medicare UPIN
AZ000010611Medicare ID - Type UnspecifiedMEDICARE PART B