Provider Demographics
NPI:1063426500
Name:KUNKLE, CAROL ANN (DPM)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:KUNKLE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 S ALEXANDRIA ST
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-1502
Mailing Address - Country:US
Mailing Address - Phone:724-539-0242
Mailing Address - Fax:724-539-6664
Practice Address - Street 1:805 S ALEXANDRIA ST
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1502
Practice Address - Country:US
Practice Address - Phone:724-539-0242
Practice Address - Fax:724-539-6664
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002230L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007691290001Medicaid
PA1457675OtherBLUE SHIELD
PA1457675OtherBLUE SHIELD
PAT29848OtherDEA
PAT29848Medicare UPIN