Provider Demographics
NPI:1508946062
Name:KUNKEL, THOMAS W (DPM)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:KUNKEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1099 EAST LIBERTY STREET
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-2407
Mailing Address - Country:US
Mailing Address - Phone:330-759-4724
Mailing Address - Fax:330-759-5168
Practice Address - Street 1:1099 EAST LIBERTY STREET
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:OH
Practice Address - Zip Code:44420-2407
Practice Address - Country:US
Practice Address - Phone:330-759-4724
Practice Address - Fax:330-759-5168
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002367K213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000135300OtherANTHEM
OH0656928Medicaid
OH0790990001Medicare NSC
T80565Medicare UPIN
OH0656928Medicaid