Provider Demographics
NPI:1952478174
Name:KUNKEL, FREDERICK W (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:W
Last Name:KUNKEL
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 1:12645 NEW BRITTANY BLVD
Mailing Address - Street 2:BLDG 15
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3631
Mailing Address - Country:US
Mailing Address - Phone:239-936-2220
Mailing Address - Fax:239-936-2444
Practice Address - Street 1:12645 NEW BRITTANY BLVD
Practice Address - Street 2:BLDG 15
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3631
Practice Address - Country:US
Practice Address - Phone:239-936-2220
Practice Address - Fax:239-936-2444
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0046480207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277199300Medicaid
FL277199300Medicaid
FL03778ZMedicare PIN