Provider Demographics
NPI:1649812777
Name:KUNZELMAN, CHAD LEE
Entity type:Individual
Prefix:MR
First Name:CHAD
Middle Name:LEE
Last Name:KUNZELMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10871 WATERLOO MUNITH RD
Mailing Address - Street 2:
Mailing Address - City:MUNITH
Mailing Address - State:MI
Mailing Address - Zip Code:49259-9661
Mailing Address - Country:US
Mailing Address - Phone:734-945-4883
Mailing Address - Fax:
Practice Address - Street 1:10871 WATERLOO MUNITH RD
Practice Address - Street 2:
Practice Address - City:MUNITH
Practice Address - State:MI
Practice Address - Zip Code:49259-9661
Practice Address - Country:US
Practice Address - Phone:734-945-4883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide