Provider Demographics
NPI:1811988702
Name:KUNSTMAN, HEIDI L (MD)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:L
Last Name:KUNSTMAN
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:PO BOX 1357
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-1357
Mailing Address - Country:US
Mailing Address - Phone:239-278-3600
Mailing Address - Fax:239-226-4650
Practice Address - Street 1:930 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LABELLE
Practice Address - State:FL
Practice Address - Zip Code:33935-4444
Practice Address - Country:US
Practice Address - Phone:863-675-0160
Practice Address - Fax:863-675-6219
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87668208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267709100Medicaid
FL71526OtherBLUE CROSS
FLH91550Medicare UPIN
FL71526ZMedicare ID - Type Unspecified