MEDICARE: KUNCHERIA JOSEPH MD 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
1	261QM2500X	Medical Specialty Clinic/Center	ME31818	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1144415324	OTHER	FL	NPPES DR KUNCHERIA JOSEPHMD

General Provider Information

NPI Number	:	1336459379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KUNCHERIA JOSEPH MD PA

Provider Business Mailing Address
First Line	:	1101 TAMIAMI TRL S
Second Line	:	SUITE 202
City	:	VENICE
State	:	FL
Zip	:	34285-4133
Country	:	US
Telephone Number	:	941-485-6969
Fax Number	:	941-894-6226

Provider Business Practice Location Address
First Line	:	1101 TAMIAMI TRL S
Second Line	:	SUITE 202
City	:	VENICE
State	:	FL
Zip	:	34285-4133
Country	:	US
Telephone Number	:	941-485-6969
Fax Number	:	941-894-6226

Authorized Official
Title or Position	:	PRESIDENT/SOLE OWNER/PHYSICIAN
Name	:	DR. KUNCHERIA JOSEPH
Credential	:	MD
Telephone Number	:	941-485-6969

Provider Enumeration Date	:	10/08/2010
Last Update Date	:	10/08/2010

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1144415324 — DR. KUNCHERIA JOSEPH MD
Practice Location Address:

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VENICE, FL
34285-4133

Practice Phone: 941-485-6969
Practice Fax: 941-894-6169

Directions to “KUNCHERIA JOSEPH MD PA ” Practice Location

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