Provider Demographics
NPI:1881662583
Name:KUNZE, RANDALL (DPM)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:
Last Name:KUNZE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-0424
Mailing Address - Country:US
Mailing Address - Phone:417-358-8566
Mailing Address - Fax:417-358-8566
Practice Address - Street 1:1503 HAZEL ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-2829
Practice Address - Country:US
Practice Address - Phone:417-358-8566
Practice Address - Fax:417-358-8566
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000634213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO3032OtherCOX HEALTH PLAN
MO139369OtherHEALTHLINK
MO302951702Medicaid
MO49433OtherBCBS MO STANDARD
MO626137103Medicaid
MO213035100Medicare ID - Type UnspecifiedMO MEDICARE
MO480033754Medicare ID - Type UnspecifiedMEDICARE RAILROAD
MO139369OtherHEALTHLINK
MO49433OtherBCBS MO STANDARD
MO000021303Medicare ID - Type UnspecifiedMO MEDICARE
MO302951702Medicaid
MO3032OtherCOX HEALTH PLAN
MOP00350052Medicare ID - Type UnspecifiedMO MEDICARE RR