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General NPI Number Information
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NPI Number | 1558332387
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Entity Type | Individual
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Provider Name | DAVID M KANUCK D P M PA
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Gender | Male
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 03/13/2017
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Provider Practice Location Address
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Address Line | 18308 MURDOCK CIR STE 102
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City | PORT CHARLOTTE
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State | FL
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Zip | 33948-1025
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Country | US
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Telephone | 239-481-7000
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Fax | 239-481-8150
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Provider Business Mailing Address
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Address Line | 8851 BOARDROOM CIR
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City | FORT MYERS
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State | FL
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Zip | 33919-4888
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Country | US
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Telephone | 239-481-7000
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Fax | 239-481-8150
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO3295
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License Number State | FL
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