Provider Demographics
NPI:1891739009
Name:CUNTZ, CECILIA M (MD)
Entity Type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:M
Last Name:CUNTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 RUE DE LA VIE ST STE 305
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-5128
Mailing Address - Country:US
Mailing Address - Phone:225-216-1118
Mailing Address - Fax:225-721-6111
Practice Address - Street 1:500 RUE DE LA VIE ST STE 305
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-5128
Practice Address - Country:US
Practice Address - Phone:225-216-1118
Practice Address - Fax:225-216-1119
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.10648R208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAF93253Medicare UPIN
LA5U818Medicare ID - Type Unspecified