Provider Demographics
NPI:1730648809
Name:MEDICO
Entity Type:Organization
Organization Name:MEDICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:928-377-2882
Mailing Address - Street 1:6120 W BELL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-3780
Mailing Address - Country:US
Mailing Address - Phone:332-633-4268
Mailing Address - Fax:866-264-4120
Practice Address - Street 1:6120 W BELL RD STE 100
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3780
Practice Address - Country:US
Practice Address - Phone:833-263-3426
Practice Address - Fax:866-264-4120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-18
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty