MEDICARE: GEETIKA KUKREJA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	4301096737	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396053351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEETIKA KUKREJA MD

Provider Business Mailing Address
First Line	:	401 S BALLENGER HWY
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48532-3638
Country	:	US
Telephone Number	:	810-342-1528
Fax Number	:

Provider Business Practice Location Address
First Line	:	3140 W CAMPUS DR
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-2776
Country	:	US
Telephone Number	:	989-667-2370
Fax Number	:	989-671-9275

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2010
Last Update Date	:	02/05/2018

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