Provider Demographics
NPI:1942205497
Name:KUNDEL PEDIATRIC ASSOCIATES, PA
Entity Type:Organization
Organization Name:KUNDEL PEDIATRIC ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KUNDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:218-722-1408
Mailing Address - Street 1:1000 E 1ST ST
Mailing Address - Street 2:STE 204
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2297
Mailing Address - Country:US
Mailing Address - Phone:218-722-1408
Mailing Address - Fax:218-722-3055
Practice Address - Street 1:1000 E 1ST ST
Practice Address - Street 2:STE 204
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2297
Practice Address - Country:US
Practice Address - Phone:218-722-1408
Practice Address - Fax:218-722-3055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN22787208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty