Provider Demographics
NPI:1811512437
Name:KUNTZELMAN, STUART (ATP)
Entity type:Individual
Prefix:MR
First Name:STUART
Middle Name:
Last Name:KUNTZELMAN
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W2678 TOWN CENTER RD
Mailing Address - Street 2:
Mailing Address - City:JUDA
Mailing Address - State:WI
Mailing Address - Zip Code:53550-9565
Mailing Address - Country:US
Mailing Address - Phone:630-806-3036
Mailing Address - Fax:
Practice Address - Street 1:W2678 TOWN CENTER RD
Practice Address - Street 2:
Practice Address - City:JUDA
Practice Address - State:WI
Practice Address - Zip Code:53550-9565
Practice Address - Country:US
Practice Address - Phone:630-806-3036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203.002025332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment