Provider Demographics
NPI:1477524148
Name:KUNESH, BENJAMIN (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:KUNESH
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 1:137 PROFESSIONAL PARK DR STE A
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6541
Mailing Address - Country:US
Mailing Address - Phone:704-660-2634
Mailing Address - Fax:
Practice Address - Street 1:137 PROFESSIONAL PARK DR STE A
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6541
Practice Address - Country:US
Practice Address - Phone:704-660-2634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400884207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3032092008OtherCIGNA
NC8633OtherPARTNERS MEDICARE CHOICE
NC895044CMedicaid
NCC2630OtherMEDCOST
NC5044COtherBCBS
NC232009OtherMEDICARE
NC4511795OtherAETNA
NCF68239Medicare UPIN
NC232009OtherMEDICARE