Provider Demographics
NPI:1629075239
Name:BOCK-KUNZ, ANDREA LEIGH (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEIGH
Last Name:BOCK-KUNZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:ATCHISON
Mailing Address - State:KS
Mailing Address - Zip Code:66002-2404
Mailing Address - Country:US
Mailing Address - Phone:913-367-4451
Mailing Address - Fax:913-367-7640
Practice Address - Street 1:605 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002-2404
Practice Address - Country:US
Practice Address - Phone:913-367-4451
Practice Address - Fax:913-367-7640
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-29
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-28552207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS2087299901Medicaid
KS100764B0Medicare ID - Type Unspecified
KS2087299901Medicaid