Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204E00000X | Oral & Maxillofacial Surgeon | 12011863A | IN |
Y | 204E00000X | Oral & Maxillofacial Surgeon | DEN00201943 | CO |
NPI | 1215190145 |
---|---|
Provider Name | Dr. Michael S Kunkel |
First Address | Colorado Springs, CO 80920 |
Second Address | Colorado Springs, CO 80920 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2008 |
Last Update Date | 24/05/2013 |