Provider Demographics
NPI:1316901598
Name:KUNTZ, TRACEY BLAIR (MD)
Entity type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:BLAIR
Last Name:KUNTZ
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2700 STANLEY GAULT PKWY
Mailing Address - Street 2:SUITE 129
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5132
Mailing Address - Country:US
Mailing Address - Phone:502-253-4917
Mailing Address - Fax:502-489-5751
Practice Address - Street 1:3940 DUPONT CIRCLE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-895-1111
Practice Address - Fax:502-895-1085
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2020-12-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY36349207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64033855Medicaid
KYK006330Medicare Oscar/Certification
KY64033855Medicaid
H39554Medicare UPIN
KY1331805Medicare ID - Type Unspecified