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NPI Code Detail

MEDICARE: DAVID M KANUCK D P M PA

MEDICARE: DAVID M KANUCK D P M PA
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
1213ES0103XFoot & Ankle Surgery PodiatristPO3295FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DN6352OTHERFLRAILROAD MEDICARE

General Provider Information

NPI Number : 1174727812
Entity Type Code : Organization
Provider Name (Legal Business Name) : DAVID M KANUCK D P M PA
Provider Business Mailing Address
First Line : 8851 BOARDROOM CIR
Second Line :
City : FORT MYERS
State : FL
Zip : 33919-4888
Country : US
Telephone Number : 239-481-7000
Fax Number : 239-481-8150
Provider Business Practice Location Address
First Line : 3191 HARBOR BLVD
Second Line : STE B
City : PORT CHARLOTTE
State : FL
Zip : 33952-6755
Country : US
Telephone Number : 239-481-7000
Fax Number : 239-481-8150
Authorized Official
Title or Position : OWNER
Name : DAVID M KANUCK
Credential : DPM
Telephone Number : 239-481-7000
Provider Enumeration Date : 06/14/2007
Last Update Date : 03/03/2011

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Directions to “DAVID M KANUCK D P M PA ” Practice Location

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