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General NPI Number Information
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NPI Number | 1336459379
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Entity Type | Organization
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Legal Business Name | KUNCHERIA JOSEPH MD PA
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Dates
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Enumeration Date | 10/08/2010
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Last Update Date | 10/08/2010
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Provider Practice Location Address
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Address Line | 1101 TAMIAMI TRL S SUITE 202
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City | VENICE
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State | FL
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Zip | 34285-4133
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Country | US
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Telephone | 941-485-6969
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Fax | 941-894-6226
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Provider Business Mailing Address
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Address Line | 1101 TAMIAMI TRL S SUITE 202
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City | VENICE
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State | FL
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Zip | 34285-4133
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Country | US
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Telephone | 941-485-6969
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Fax | 941-894-6226
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Authorized Official
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Title or Position | PRESIDENT/SOLE OWNER/PHYSICIAN
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Name | DR. KUNCHERIA JOSEPH
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Credential | MD
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Telephone | 941-485-6969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | ME31818
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License Number State | FL
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