Healthcare Provider Details

I. General information

NPI: 1669901831
Provider Name (Legal Business Name): CARL RYAN TUNINK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2017
Last Update Date: 09/12/2022
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N HOSPITAL DR
FULTON MO
65251-2511
US

IV. Provider business mailing address

PO BOX 843966
KANSAS CITY MO
64184-3966
US

V. Phone/Fax

Practice location:
  • Phone: 573-642-5911
  • Fax: 573-642-3015
Mailing address:
  • Phone: 573-884-3300
  • Fax: 573-884-0943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2020020192
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number2020020192
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: