Provider Demographics
NPI:1285683326
Name:SPRUNGER, KURT W (MD)
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:W
Last Name:SPRUNGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 E BELL RD STE 5300
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2188
Mailing Address - Country:US
Mailing Address - Phone:602-422-9690
Mailing Address - Fax:602-422-9680
Practice Address - Street 1:3805 E BELL RD STE 5300
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2188
Practice Address - Country:US
Practice Address - Phone:602-422-9690
Practice Address - Fax:602-422-9680
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036145819208600000X
WY11528C208600000X
AZ37779208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ507707OtherMEDICAID PROVIDER NUMBER
AZ507707OtherMEDICAID PROVIDER NUMBER
E24166Medicare UPIN