Healthcare Provider Details

I. General information

NPI: 1588628077
Provider Name (Legal Business Name): KUTZTOWN FAMILY MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15050 KUTZTOWN RD
KUTZTOWN PA
19530-9275
US

IV. Provider business mailing address

15050 KUTZTOWN RD
KUTZTOWN PA
19530-9275
US

V. Phone/Fax

Practice location:
  • Phone: 610-683-7393
  • Fax: 610-683-5470
Mailing address:
  • Phone: 610-683-7393
  • Fax: 610-683-5470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MS. NATALIE MARIE KUNSMAN-GRIDER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 610-683-7393