Provider Demographics
NPI:1851345862
Name:KUNST, OTTO J (MD)
Entity Type:Individual
Prefix:
First Name:OTTO
Middle Name:J
Last Name:KUNST
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 1:13151 PARKLINE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-7929
Mailing Address - Country:US
Mailing Address - Phone:239-561-5161
Mailing Address - Fax:
Practice Address - Street 1:13151 PARKLINE DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-7929
Practice Address - Country:US
Practice Address - Phone:239-561-5161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME243682085R0202X
WV113212085R0202X
OH35-04-6413-K2085R0202X
MA485252085R0202X
NC260632085R0202X
PAMD-031175-E2085R0202X
NE193042085R0202X
IN01042077A2085R0202X
MI43010628742085R0202X
VA01010507522085R0202X
MDD00467232085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV11321OtherWEST VIRGINIA LICENSE
48949OtherBCBS
VA0101050752OtherVIRGINIA LICENSE
NE19304OtherNEBRASKA LICENSE
FL270831100Medicaid
MA48525OtherMASSACHUSETTS LICENSE
MDD0046723OtherMARYLAND LICENSE
PAMD-031175-EOtherPENNSYLVANIA LICENSE
IN01042077AOtherINDIANA LICENSE
NC26063OtherNORTH CAROLINA LICENSE
OH35-04-6413-KOtherOHIO LICENSE
MI4301062874OtherMICHIGAN LICENSE
FLME24368OtherFLORIDA LICENSE
P00145536Medicare PIN
MDD0046723OtherMARYLAND LICENSE
NE19304OtherNEBRASKA LICENSE