Provider Demographics
NPI:1740524172
Name:KUNCKEL, DALE W (CSA)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:W
Last Name:KUNCKEL
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E RAND RD
Mailing Address - Street 2:SUITE 347
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-3103
Mailing Address - Country:US
Mailing Address - Phone:877-230-9617
Mailing Address - Fax:
Practice Address - Street 1:309 E RAND RD
Practice Address - Street 2:SUITE 347
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-3103
Practice Address - Country:US
Practice Address - Phone:419-351-8944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2995246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant