Provider Demographics
NPI:1609494194
Name:KAUNDA, JOSEPH GORDON
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:GORDON
Last Name:KAUNDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8841 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-1486
Mailing Address - Country:US
Mailing Address - Phone:269-277-7658
Mailing Address - Fax:
Practice Address - Street 1:8841 MEADOW LN
Practice Address - Street 2:
Practice Address - City:BERRIEN SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49103-1486
Practice Address - Country:US
Practice Address - Phone:269-277-7658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704268600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily