Provider Demographics
NPI:1457399222
Name:KUNKEL, JOHN F (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:KUNKEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40450
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140-0450
Mailing Address - Country:US
Mailing Address - Phone:440-871-4700
Mailing Address - Fax:440-871-4702
Practice Address - Street 1:518 GLACIER HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44509-1920
Practice Address - Country:US
Practice Address - Phone:330-507-7999
Practice Address - Fax:330-792-6309
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-2744-K213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH480016576OtherMEDICARE RAILROAD PIN
OH0897712Medicaid
OH0897712Medicaid
OH480016576OtherMEDICARE RAILROAD PIN
OH4310030001Medicare NSC