Basic Information
| Provider Information | |||||||||
| NPI: | 1386845758 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUNKLE | ||||||||
| FirstName: | RAMA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9225 N 3RD STREET | ||||||||
| Address2: | 300 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850202473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024450751 | ||||||||
| FaxNumber: | 6024248128 | ||||||||
| Practice Location | |||||||||
| Address1: | 9225 N 3RD STREET | ||||||||
| Address2: | 300 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850202473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024450751 | ||||||||
| FaxNumber: | 6024248128 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2007 | ||||||||
| LastUpdateDate: | 06/02/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4698 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 232229 | 05 | AZ | MEDICAID | 232229-01 | 05 | AZ | MEDICAID |