Healthcare Provider Details

I. General information

NPI: 1083683361
Provider Name (Legal Business Name): WILLIAM J KUNCEWITCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 02/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4075 STATE ROAD 7 SUITE H1
LAKE WORTH FL
33449-8186
US

IV. Provider business mailing address

900 S PINE ISLAND RD SUITE 800
PLANTATION FL
33324-3920
US

V. Phone/Fax

Practice location:
  • Phone: 561-967-5761
  • Fax: 561-967-5762
Mailing address:
  • Phone: 561-967-5761
  • Fax: 561-967-5762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number147485
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME125419
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: