Healthcare Provider Details

I. General information

NPI: 1295266328
Provider Name (Legal Business Name): BENJAMIN NORRIS KUNEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 07/06/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 TULANE AVE
NEW ORLEANS LA
70112-2600
US

IV. Provider business mailing address

1430 TULANE AVE DEPARTMENT OF RADIOLOGY
NEW ORLEANS LA
70112
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-5263
  • Fax: 504-988-3971
Mailing address:
  • Phone: 504-988-7627
  • Fax: 504-988-7616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number334493
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number036.160889
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: