Provider Demographics
NPI:1740261312
Name:KUNBERGER, LAURA ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ELIZABETH
Last Name:KUNBERGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5101 4TH AVENUE CIR E STE 100
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-5625
Mailing Address - Country:US
Mailing Address - Phone:941-782-0414
Mailing Address - Fax:941-782-0418
Practice Address - Street 1:5101 4TH AVENUE CIR E STE 100
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-5625
Practice Address - Country:US
Practice Address - Phone:941-782-0414
Practice Address - Fax:941-782-0418
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00603392085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258669000Medicaid
FL44959ZMedicare ID - Type Unspecified
FL258669000Medicaid