Healthcare Provider Details

I. General information

NPI: 1245468321
Provider Name (Legal Business Name): MICHAEL P KUNCEWITCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N MOUNTAIN RD STE 202
PLAINVILLE CT
06062-1848
US

IV. Provider business mailing address

201 N MOUNTAIN RD STE 202
PLAINVILLE CT
06062-1848
US

V. Phone/Fax

Practice location:
  • Phone: 860-696-2040
  • Fax:
Mailing address:
  • Phone: 860-696-2040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number84913
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number84913
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: