Provider Demographics
NPI:1962543231
Name:KUNESH, MICHAEL T (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:KUNESH
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 1:2601 FAR HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-1634
Mailing Address - Country:US
Mailing Address - Phone:937-298-1703
Mailing Address - Fax:937-298-6344
Practice Address - Street 1:2601 FAR HILLS AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45419-1634
Practice Address - Country:US
Practice Address - Phone:937-298-1703
Practice Address - Fax:937-298-6344
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35056069207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0821696Medicaid
OH000000006870OtherANTHEM
0820117OtherUNITED HEALTH CARE
1369116OtherUMWA
OH000000006870OtherANTHEM
OH0821696Medicaid