Healthcare Provider Details

I. General information

NPI: 1265488928
Provider Name (Legal Business Name): MARC W KUNDLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2868 ACTON ROAD
BIRMINGHAM AL
35243
US

IV. Provider business mailing address

2868 ACTON ROAD
BIRMINGHAM AL
35243
US

V. Phone/Fax

Practice location:
  • Phone: 205-968-8360
  • Fax: 205-968-8373
Mailing address:
  • Phone: 205-968-8360
  • Fax: 205-968-8373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25390
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: