Healthcare Provider Details

I. General information

NPI: 1053314278
Provider Name (Legal Business Name): BRETT ROGER KUNS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 10/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S WASHINGTON ST
CASTALIA OH
44824-9262
US

IV. Provider business mailing address

1031 PIERCE ST SUITE D
SANDUSKY OH
44870-4669
US

V. Phone/Fax

Practice location:
  • Phone: 419-684-5369
  • Fax: 419-684-7238
Mailing address:
  • Phone: 419-557-5568
  • Fax: 419-557-5542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34004347
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: