Provider Demographics
NPI:1588972889
Name:KUNSMAN, GLENN RICHARD (DO)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:RICHARD
Last Name:KUNSMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6120 W BELL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-3780
Mailing Address - Country:US
Mailing Address - Phone:833-263-3426
Mailing Address - Fax:866-264-4120
Practice Address - Street 1:6120 W BELL RD STE 100
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3780
Practice Address - Country:US
Practice Address - Phone:833-263-3426
Practice Address - Fax:866-264-4120
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO1822207P00000X
TXQ5012207P00000X
AZ005538207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine