Healthcare Provider Details

I. General information

NPI: 1538200712
Provider Name (Legal Business Name): KRISTINE A KUNESH-PART M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINE A KUNESH

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 FAR HILLS AVE
DAYTON OH
45419-1634
US

IV. Provider business mailing address

2601 FAR HILLS AVE
DAYTON OH
45419-1634
US

V. Phone/Fax

Practice location:
  • Phone: 937-298-1703
  • Fax: 937-298-6344
Mailing address:
  • Phone: 937-298-1703
  • Fax: 937-298-6344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35049142
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: