Provider Demographics
NPI:1992128813
Name:KUNKLE, WILLIAM AARON (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:AARON
Last Name:KUNKLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 GLADES RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6464
Mailing Address - Country:US
Mailing Address - Phone:561-495-9511
Mailing Address - Fax:561-990-7426
Practice Address - Street 1:5800 CORPORATE WAY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2004
Practice Address - Country:US
Practice Address - Phone:561-495-9511
Practice Address - Fax:561-990-7426
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-29
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS20443207XS0117X
ORDO181695207XS0117X
IN02006149A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300043580Medicaid