Provider Demographics
NPI:1811061120
Name:KUENZLI, CARL EDWIN (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:EDWIN
Last Name:KUENZLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3492 CANDY LN
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-4412
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3492 CANDY LN
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-4412
Practice Address - Country:US
Practice Address - Phone:765-455-1846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037339A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000111168OtherANTHEM
IN100137430AMedicaid
110210092OtherMEDICARE RR RETIREE
IN100137430AMedicaid
INE21282Medicare UPIN
ININ1663042Medicare PIN