Individual
MATTHEW NICHOLAS KUNKELMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
187 BUNCH FORD RD, HOLLY HILL, SC 29059-8224
(803) 496-3312
(803) 496-7713
Mailing address
PO BOX 1245, ORANGEBURG, SC 29116-1245
(803) 395-4497
(803) 395-2237
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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