Provider Demographics
NPI:1992076624
Name:KUNIN, AUDREY GOTTLIEB (MD)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:GOTTLIEB
Last Name:KUNIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 MCGEE ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-1827
Mailing Address - Country:US
Mailing Address - Phone:816-472-5700
Mailing Address - Fax:816-472-5752
Practice Address - Street 1:1901 MCGEE ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-1827
Practice Address - Country:US
Practice Address - Phone:816-472-5700
Practice Address - Fax:816-472-5752
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO104910207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology