Healthcare Provider Details

I. General information

NPI: 1114922754
Provider Name (Legal Business Name): RAY L KUNDEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date: 03/20/2006
Reactivation Date: 03/28/2006

III. Provider practice location address

1000 E 1ST ST STE 204
DULUTH MN
55805-2297
US

IV. Provider business mailing address

1000 E 1ST ST STE 204
DULUTH MN
55805-2297
US

V. Phone/Fax

Practice location:
  • Phone: 218-722-1408
  • Fax: 218-722-3055
Mailing address:
  • Phone: 218-722-1408
  • Fax: 218-722-3055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number22787
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: