Basic Information
| Provider Information | |||||||||
| NPI: | 1861405474 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUNZ | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2178 S 900 E | ||||||||
| Address2: | STE 1 | ||||||||
| City: | SALT LAKE CTY, | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841062388 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014661333 | ||||||||
| FaxNumber: | 8014666601 | ||||||||
| Practice Location | |||||||||
| Address1: | 2178 S 900 E | ||||||||
| Address2: | STE 1 | ||||||||
| City: | SALT LAKE CTY, | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841062388 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014661333 | ||||||||
| FaxNumber: | 8014666601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2006 | ||||||||
| LastUpdateDate: | 10/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 101599-0501 | UT | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
No ID Information.