Healthcare Provider Details

I. General information

NPI: 1346365244
Provider Name (Legal Business Name): DR. THOMAS RICHARD KUNSTMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WARDENBURG HEALTH CTR UNIVERSITY OF COLORADO
BOULDER CO
80309-0119
US

IV. Provider business mailing address

640 ITHACA DR DRIVE
BOULDER CO
80305-5632
US

V. Phone/Fax

Practice location:
  • Phone: 303-492-5101
  • Fax:
Mailing address:
  • Phone: 303-492-5101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number33985
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: