MEDICARE: JOSEPH GORDON KAUNDA

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	363LF0000X	Family Nurse Practitioner	4704268600	MI

General Provider Information

NPI Number	:	1609494194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH GORDON KAUNDA

Provider Business Mailing Address
First Line	:	8841 MEADOW LN
Second Line	:
City	:	BERRIEN SPRINGS
State	:	MI
Zip	:	49103-1486
Country	:	US
Telephone Number	:	269-277-7658
Fax Number	:

Provider Business Practice Location Address
First Line	:	8841 MEADOW LN
Second Line	:
City	:	BERRIEN SPRINGS
State	:	MI
Zip	:	49103-1486
Country	:	US
Telephone Number	:	269-277-7658
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2020
Last Update Date	:	07/10/2020

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Directions to “ JOSEPH GORDON KAUNDA ” Practice Location

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