Provider Demographics
NPI:1902823883
Name:KUNDEL, KATHLEEN JOY (RT(R)(M))
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:JOY
Last Name:KUNDEL
Suffix:
Gender:F
Credentials:RT(R)(M)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 E STEARNS AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMBERLAIN
Mailing Address - State:SD
Mailing Address - Zip Code:57325-1450
Mailing Address - Country:US
Mailing Address - Phone:605-734-5383
Mailing Address - Fax:
Practice Address - Street 1:MAIN STREET,JUNCTION 34 N47
Practice Address - Street 2:
Practice Address - City:FORT THOMPSON
Practice Address - State:SD
Practice Address - Zip Code:57339-0200
Practice Address - Country:US
Practice Address - Phone:605-245-2533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2471C3401X, 2471S1302X
SD1476462471C3402X, 2471M2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography
Not Answered2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
Not Answered2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammography
Not Answered2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD2471C3402XOtherCT
SD2471C3402XOtherSONOGRAPHY