Healthcare Provider Details

I. General information

NPI: 1942205497
Provider Name (Legal Business Name): KUNDEL PEDIATRIC ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

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: RAY L KUNDEL
Title or Position: OWNER
Credential: M.D.
Phone: 218-722-1408