Healthcare Provider Details

I. General information

NPI: 1114915824
Provider Name (Legal Business Name): RENE E KUNHARDT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 LITTLE RD
TRINITY FL
34655-4421
US

IV. Provider business mailing address

2035 LITTLE RD
TRINITY FL
34655-4421
US

V. Phone/Fax

Practice location:
  • Phone: 727-842-9486
  • Fax: 727-849-2623
Mailing address:
  • Phone: 727-842-9486
  • Fax: 727-849-2623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME79231
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME79231
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: