Provider Demographics
NPI:1023297017
Name:KUNTZ, REBECCA LYNN (MD)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LYNN
Last Name:KUNTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LYNN
Other - Last Name:LAURITZEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:925 E SUPERIOR ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2238
Mailing Address - Country:US
Mailing Address - Phone:218-722-3700
Mailing Address - Fax:218-722-8705
Practice Address - Street 1:925 E SUPERIOR ST
Practice Address - Street 2:SUITE 109
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2238
Practice Address - Country:US
Practice Address - Phone:218-722-3700
Practice Address - Fax:218-722-8705
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI52482-202085R0202X
MN569702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology