Provider Demographics
NPI:1639210925
Name:KANITKAR, KUNAL D (MD)
Entity Type:Individual
Prefix:
First Name:KUNAL
Middle Name:D
Last Name:KANITKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 W BUTLER ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-2606
Mailing Address - Country:US
Mailing Address - Phone:803-359-8777
Mailing Address - Fax:803-359-1513
Practice Address - Street 1:340 W BUTLER ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2606
Practice Address - Country:US
Practice Address - Phone:803-359-8777
Practice Address - Fax:803-359-1513
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24113207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCI14589Medicare UPIN