MEDICARE: RICHARD E KUNZ DPM INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	101599-0501	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164751954
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD E KUNZ DPM INC

Provider Business Mailing Address
First Line	:	2178 S 900 E
Second Line	:	SUITE #1
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-2388
Country	:	US
Telephone Number	:	801-466-1333
Fax Number	:	801-466-6601

Provider Business Practice Location Address
First Line	:	2178 S 900 E
Second Line	:	SUITE #1
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-2388
Country	:	US
Telephone Number	:	801-466-1333
Fax Number	:	801-466-6601

Authorized Official
Title or Position	:	PODIATRIST
Name	:	DR. RICHARD E. KUNZ
Credential	:	DPM
Telephone Number	:	801-466-1333

Provider Enumeration Date	:	12/08/2009
Last Update Date	:	12/08/2009

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