Healthcare Provider Details

I. General information

NPI: 1871268573
Provider Name (Legal Business Name): ZACHARY ALLEN KUENSTLE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1952 MCDOWELL RD SUITE 305
NAPERVILLE IL
60563
US

IV. Provider business mailing address

1952 MCDOWELL RD SUITE 305
NAPERVILLE IL
60563
US

V. Phone/Fax

Practice location:
  • Phone: 630-689-1022
  • Fax:
Mailing address:
  • Phone: 630-689-1022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.008659
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1181911
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: