Provider Demographics
NPI:1609056282
Name:KORUNDA MEDICAL, LLC
Entity Type:Organization
Organization Name:KORUNDA MEDICAL, LLC
Other - Org Name:KORUNDA PAIN MANAGEMENT CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZDENKO
Authorized Official - Middle Name:
Authorized Official - Last Name:KORUNDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-591-2803
Mailing Address - Street 1:PO BOX 110820
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-0114
Mailing Address - Country:US
Mailing Address - Phone:239-591-2803
Mailing Address - Fax:239-594-5637
Practice Address - Street 1:4513 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-8884
Practice Address - Country:US
Practice Address - Phone:239-591-2803
Practice Address - Fax:239-594-5637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114039207Q00000X
FLME82233207R00000X
FLOS111782081P2900X
FLME86588208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6587520001Medicare NSC
FLAG851Medicare PIN