Healthcare Provider Details

I. General information

NPI: 1285585737
Provider Name (Legal Business Name): SOUTHWEST PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5292 S COLLEGE DR
MURRAY UT
84123-2958
US

IV. Provider business mailing address

5292 S COLLEGE DR
MURRAY UT
84123-2958
US

V. Phone/Fax

Practice location:
  • Phone: 317-201-5708
  • Fax:
Mailing address:
  • Phone: 317-201-5708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RYAN PATRICK KUNKEL
Title or Position: SURGEON/OWNER
Credential: MD
Phone: 317-201-5708