Individual
GLENN A. KUNKEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 W 10TH ST, ROLLA, MO 65401-2905
(573) 458-8899
(573) 341-5611
Mailing address
P.O. BOX 1216, ROLLA, MO 65402
(573) 364-2200
(573) 364-7600
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
113756
MO
207L00000X
Anesthesiology Physician
Primary
113756
MO
208VP0000X
Pain Medicine Physician
113756
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209664002
—
MO
Enumeration date
06/27/2005
Last updated
11/02/2023
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