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Individual
MATTHEW NICHOLAS KUNKELMAN
Active
Individual
MATTHEW NICHOLAS KUNKELMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2209
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4173
MEDICARE PTAN
SC
01
—
423828
MEDICARE RHC
SC
01
—
428926
MEDICARE RHC
SC
05
—
PC4116
—
SC
05
—
RHC012
—
SC
05
—
RHC020
—
SC
05
—
RHC151
—
SC
Enumeration date
10/28/2014
Last updated
01/06/2017
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