Basic Information
| Provider Information | |||||||||
| NPI: | 1851320535 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUNOS | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD,PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 525 E MARKET ST | ||||||||
| Address2: | PO BOX 2090 | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443041619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309968603 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 ROSE ST | ||||||||
| Address2: | RM C114, PAVILION H | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592577618 | ||||||||
| FaxNumber: | 8592574060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 03/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 35088256 | OH | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 53743 | KY | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 2677152 | 05 | OH | MEDICAID |