Basic Information
| Provider Information | |||||||||
| NPI: | 1851358949 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUNDRA | ||||||||
| FirstName: | HENA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1814 | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | OH | ||||||||
| PostalCode: | 433011814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403837003 | ||||||||
| FaxNumber: | 7403837942 | ||||||||
| Practice Location | |||||||||
| Address1: | 1040 DELAWARE AVENUE | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | OH | ||||||||
| PostalCode: | 433011814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403837000 | ||||||||
| FaxNumber: | 7403837942 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2006 | ||||||||
| LastUpdateDate: | 12/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35075754K | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110190561 | 01 | TRAVELERS MEDICARE | OTHER | 0404631 | 01 | UHC | OTHER | 311098079 | 01 | CIGNA | OTHER | 311098079 | 01 | PPO NEXT | OTHER | 000000118375 | 01 | OH | ANTHEM | OTHER | 2184666 | 01 | AETNA | OTHER | 2107759 | 05 | OH | MEDICAID |