MEDICARE: RONALD P. KUFNER M.D., P.C.

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	261QP3300X	Pain Clinic/Center		MI

General Provider Information

NPI Number	:	1518106525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RONALD P. KUFNER M.D., P.C.

Provider Business Mailing Address
First Line	:	4633 W KENSINGTON AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-8341
Country	:	US
Telephone Number	:	616-308-9860
Fax Number	:	616-874-8218

Provider Business Practice Location Address
First Line	:	5050 CASCADE RD SE
Second Line	:	SUITE C
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-3707
Country	:	US
Telephone Number	:	616-308-9860
Fax Number	:	616-874-8218

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RONALD PAUL KUFNER
Credential	:	M.D.
Telephone Number	:	616-308-9860

Provider Enumeration Date	:	02/13/2009
Last Update Date	:	04/29/2012

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