Provider Demographics
NPI:1295430916
Name:KUNZEMAN, JOHN MITCHELL (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MITCHELL
Last Name:KUNZEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MITCH
Other - Middle Name:
Other - Last Name:KUNZEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3204 LAKEMERE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-9310
Mailing Address - Country:US
Mailing Address - Phone:217-725-1088
Mailing Address - Fax:
Practice Address - Street 1:2301 HOLMES ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2640
Practice Address - Country:US
Practice Address - Phone:816-404-4175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023019679207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program