MEDICARE: DR. MARY LOUISE KUNDRAT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD-018828E	PA

General Provider Information

NPI Number	:	1881692879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY LOUISE KUNDRAT M.D.

Provider Business Mailing Address
First Line	:	4928 BAYARD ST
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15213-1802
Country	:	US
Telephone Number	:	412-682-3848
Fax Number	:	412-544-2950

Provider Business Practice Location Address
First Line	:	120 5TH AVE
Second Line	:	HIGHMARK P-4205
City	:	PITTSBURGH
State	:	PA
Zip	:	15222-3000
Country	:	US
Telephone Number	:	412-544-3091
Fax Number	:	412-544-2950

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	07/08/2007

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