Individual
DAVID M KANUCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D P M PA
Contact information
Practice address
18308 MURDOCK CIR, STE 102, PORT CHARLOTTE, FL 33948-1025
(239) 481-7000
(239) 481-8150
Mailing address
8851 BOARDROOM CIR, FORT MYERS, FL 33919-4888
(239) 481-7000
(239) 481-8150
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
PO3295
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14-1989478
TAX ID
FL
01
—
P00630109
RAILROAD MEDICARE
FL
01
—
PO3295
LICENSE
FL
Enumeration date
01/30/2006
Last updated
03/13/2017
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