Provider Demographics
NPI:1689612343
Name:KUNZ, BRADLEY LEGAN (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:LEGAN
Last Name:KUNZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BRADLEY
Other - Middle Name:L
Other - Last Name:KUNZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1120 POLARIS PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43240-4042
Mailing Address - Country:US
Mailing Address - Phone:614-797-0600
Mailing Address - Fax:614-797-0600
Practice Address - Street 1:1120 POLARIS PKWY STE 110
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-4042
Practice Address - Country:US
Practice Address - Phone:614-797-0600
Practice Address - Fax:614-797-0600
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.071584207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2079585Medicaid
OHKU0866543Medicare PIN
G88544Medicare UPIN
OH1838753OtherUNITED HEALTHCARE OF OHIO
OHKU0866543Medicare PIN