Healthcare Provider Details

I. General information

NPI: 1609270610
Provider Name (Legal Business Name): KORUNDA MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 10/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4513 EXECUTIVE DRIVE UNIT 101
NAPLES FL
34119
US

IV. Provider business mailing address

4513 EXECUTIVE DR UNIT 101
NAPLES FL
34119-9033
US

V. Phone/Fax

Practice location:
  • Phone: 239-591-2803
  • Fax:
Mailing address:
  • Phone: 239-591-2803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number800027001
License Number StateFL

VIII. Authorized Official

Name: MS. JENNIFER A CHOY
Title or Position: OFFICE MANAGER
Credential:
Phone: 239-591-2803