MEDICARE: KORUNDA MEDICAL, LLC

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	208VP0014X	Interventional Pain Medicine Physician	ME124754	FL

General Provider Information

NPI Number	:	1548788292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KORUNDA MEDICAL, LLC

Provider Business Mailing Address
First Line	:	PO BOX 110820
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34108-0114
Country	:	US
Telephone Number	:	239-591-2803
Fax Number	:	239-594-5637

Provider Business Practice Location Address
First Line	:	26741 DUBLIN WOODS CIR
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34135-7272
Country	:	US
Telephone Number	:	239-591-2803
Fax Number	:	239-594-5637

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	ZDENKO KORUNDA
Credential	:	MD
Telephone Number	:	239-591-2803

Provider Enumeration Date	:	09/01/2017
Last Update Date	:	06/16/2018

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