Basic Information
| Provider Information | |||||||||
| NPI: | 1629556923 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUNZE | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | RBT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12650 HAMILTON CROSSING BLVD | ||||||||
| Address2: | |||||||||
| City: | CARMEL | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460325400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172492242 | ||||||||
| FaxNumber: | 3176631175 | ||||||||
| Practice Location | |||||||||
| Address1: | 3101 N CANTERBURY CT | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474041500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8126503032 | ||||||||
| FaxNumber: | 3176631175 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2018 | ||||||||
| LastUpdateDate: | 07/30/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y |
No ID Information.