Provider Demographics
NPI:1689677825
Name:KUNKEL, MICHAEL RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RAY
Last Name:KUNKEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 100174
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-3174
Mailing Address - Country:US
Mailing Address - Phone:864-512-6024
Mailing Address - Fax:864-512-6123
Practice Address - Street 1:2000 E GREENVILLE ST
Practice Address - Street 2:STE 3850
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1580
Practice Address - Country:US
Practice Address - Phone:864-512-6024
Practice Address - Fax:864-512-6123
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC20071207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC200713Medicaid
3619Medicare PIN
SC200713Medicaid