Active NPI
Ray L Kundel, M.D.
- Pediatrics Physician
- Duluth, MN
National Provider Identifier
1114922754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 22787
- Practice address
- 1000 E 1St St
Ste 204
Duluth, MN 55805-2297 - Phone
- (218) 722-1408
- Fax
- (218) 722-3055
- NPI assigned
- Jun 20, 2005
- Reactivated
- Mar 28, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 22787 | MN | Primary |
Addresses
Primary practice location
1000 E 1St St
Ste 204
Duluth, MN 55805-2297
Mailing address
1000 E 1St St
Ste 204
Duluth, MN 55805-2297
Phone (218) 722-1408
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 885285500 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22787 | MN | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346112000000",
"number": "1114922754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 E 1ST ST",
"address_2": "STE 204",
"city": "DULUTH",
"state": "MN",
"postal_code": "558052297",
"telephone_number": "218-722-1408",
"fax_number": "218-722-3055"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 E 1ST ST",
"address_2": "STE 204",
"city": "DULUTH",
"state": "MN",
"postal_code": "558052297",
"telephone_number": "218-722-1408",
"fax_number": "218-722-3055"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUNDEL",
"first_name": "RAY",
"middle_name": "L",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-20",
"last_updated": "2012-08-28",
"deactivation_date": "2006-03-20",
"reactivation_date": "2006-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MN",
"license": "22787",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "885285500",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Duluth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.