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NPI Code Detail

MEDICARE: KUNDEL PEDIATRIC ASSOCIATES, PA

MEDICARE: KUNDEL PEDIATRIC ASSOCIATES, 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
1208000000XPediatrics Physician22787MN

General Provider Information

NPI Number : 1942205497
Entity Type Code : Organization
Provider Name (Legal Business Name) : KUNDEL PEDIATRIC ASSOCIATES, PA
Provider Business Mailing Address
First Line : 1000 E 1ST ST
Second Line : STE 204
City : DULUTH
State : MN
Zip : 55805-2297
Country : US
Telephone Number : 218-722-1408
Fax Number : 218-722-3055
Provider Business Practice Location Address
First Line : 1000 E 1ST ST
Second Line : STE 204
City : DULUTH
State : MN
Zip : 55805-2297
Country : US
Telephone Number : 218-722-1408
Fax Number : 218-722-3055
Authorized Official
Title or Position : OWNER
Name : RAY L KUNDEL
Credential : M.D.
Telephone Number : 218-722-1408
Provider Enumeration Date : 06/20/2005
Last Update Date : 08/22/2020

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