Provider Demographics
NPI:1134210727
Name:KUNTZE, JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:KUNTZE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3599 SUELDO ST
Mailing Address - Street 2:110
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7329
Mailing Address - Country:US
Mailing Address - Phone:805-786-2500
Mailing Address - Fax:805-781-0423
Practice Address - Street 1:1310 LAS TABLAS RD
Practice Address - Street 2:SUITE 201
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9737
Practice Address - Country:US
Practice Address - Phone:805-786-2500
Practice Address - Fax:805-781-0423
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG46309208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G463090Medicaid
CAA50351Medicare UPIN
CAWG46309DMedicare PIN
CA00G463090Medicaid