Healthcare Provider Details

I. General information

NPI: 1811988702
Provider Name (Legal Business Name): HEIDI L KUNSTMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 S MAIN ST
LABELLE FL
33935-4444
US

IV. Provider business mailing address

PO BOX 1357
FORT MYERS FL
33902-1357
US

V. Phone/Fax

Practice location:
  • Phone: 863-675-0160
  • Fax: 863-675-6219
Mailing address:
  • Phone: 239-278-3600
  • Fax: 239-226-4650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME87668
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: