Provider Demographics
NPI:1154536878
Name:THOMAS W. KUNKEL, DPM, INC.
Entity type:Organization
Organization Name:THOMAS W. KUNKEL, DPM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:KUNKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-759-4724
Mailing Address - Street 1:1099 E LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-2407
Mailing Address - Country:US
Mailing Address - Phone:330-759-4724
Mailing Address - Fax:330-759-5168
Practice Address - Street 1:1099 E LIBERTY ST
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:OH
Practice Address - Zip Code:44420-2407
Practice Address - Country:US
Practice Address - Phone:330-759-4724
Practice Address - Fax:330-759-5168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002367K213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2354456Medicaid
OH0790990001Medicare NSC
OH9267781Medicare PIN