MEDICARE: OTTO J KUNST MD

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	2085R0202X	Diagnostic Radiology Physician	ME24368	FL
2	2085R0202X	Diagnostic Radiology Physician	11321	WV
3	2085R0202X	Diagnostic Radiology Physician	35-04-6413-K	OH
4	2085R0202X	Diagnostic Radiology Physician	48525	MA
5	2085R0202X	Diagnostic Radiology Physician	26063	NC
6	2085R0202X	Diagnostic Radiology Physician	MD-031175-E	PA
7	2085R0202X	Diagnostic Radiology Physician	19304	NE
8	2085R0202X	Diagnostic Radiology Physician	01042077A	IN
9	2085R0202X	Diagnostic Radiology Physician	4301062874	MI
10	2085R0202X	Diagnostic Radiology Physician	0101050752	VA
11	2085R0202X	Diagnostic Radiology Physician	D0046723	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11321	OTHER	WV	WEST VIRGINIA LICENSE
2	48949	OTHER		BCBS
3	0101050752	OTHER	VA	VIRGINIA LICENSE
4	19304	OTHER	NE	NEBRASKA LICENSE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	48525	OTHER	MA	MASSACHUSETTS LICENSE
7	D0046723	OTHER	MD	MARYLAND LICENSE
8	MD-031175-E	OTHER	PA	PENNSYLVANIA LICENSE
9	01042077A	OTHER	IN	INDIANA LICENSE
10	26063	OTHER	NC	NORTH CAROLINA LICENSE
11	35-04-6413-K	OTHER	OH	OHIO LICENSE
12	4301062874	OTHER	MI	MICHIGAN LICENSE
13	ME24368	OTHER	FL	FLORIDA LICENSE

General Provider Information

NPI Number	:	1851345862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OTTO J KUNST MD

Provider Business Mailing Address
First Line	:	13151 PARKLINE DR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33913-7929
Country	:	US
Telephone Number	:	239-561-5161
Fax Number	:

Provider Business Practice Location Address
First Line	:	13151 PARKLINE DR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33913-7929
Country	:	US
Telephone Number	:	239-561-5161
Fax Number	:

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

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	08/25/2009

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Directions to “ OTTO J KUNST MD” Practice Location

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