Healthcare Provider Details

I. General information

NPI: 1922090596
Provider Name (Legal Business Name): KRZYSZTOF K KUNDO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 PLEASANT ST SUITE 604
FALL RIVER MA
02721-3005
US

IV. Provider business mailing address

289 PLEASANT ST SUITE 604
FALL RIVER MA
02721-3005
US

V. Phone/Fax

Practice location:
  • Phone: 508-672-6068
  • Fax: 508-672-6206
Mailing address:
  • Phone: 508-672-6068
  • Fax: 508-672-6206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number253761
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number11334R
License Number StateLA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier163825601
Identifier TypeMEDICAID
Identifier StateTX
Identifier Issuer
# 2
Identifier1661970
Identifier TypeMEDICAID
Identifier StateLA
Identifier Issuer
# 3
Identifier4414280
Identifier TypeOTHER
Identifier State
Identifier IssuerECFMC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: