Provider Demographics
NPI:1588628077
Name:KUTZTOWN FAMILY MEDICINE, PC
Entity Type:Organization
Organization Name:KUTZTOWN FAMILY MEDICINE, PC
Other - Org Name:KUTZTOWN FAMILY MEDICINE, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KUNSMAN-GRIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-683-7393
Mailing Address - Street 1:15050 KUTZTOWN RD
Mailing Address - Street 2:
Mailing Address - City:KUTZTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19530-9275
Mailing Address - Country:US
Mailing Address - Phone:610-683-7393
Mailing Address - Fax:610-683-5470
Practice Address - Street 1:15050 KUTZTOWN RD
Practice Address - Street 2:
Practice Address - City:KUTZTOWN
Practice Address - State:PA
Practice Address - Zip Code:19530-9275
Practice Address - Country:US
Practice Address - Phone:610-683-7393
Practice Address - Fax:610-683-5470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA021461Medicare ID - Type Unspecified