Healthcare Provider Details

I. General information

NPI: 1982868865
Provider Name (Legal Business Name): JUNELL CAROL KOBERLEIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6804 CECELIA DRIVE
NEW PORT RICHEY FL
34653-4935
US

IV. Provider business mailing address

6804 CECELIA DRIVE
NEW PORT RICHEY FL
34653-4935
US

V. Phone/Fax

Practice location:
  • Phone: 855-232-0644
  • Fax: 888-546-0488
Mailing address:
  • Phone: 855-232-0644
  • Fax: 888-546-0488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301092909
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME165510
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2014-01439
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: