MEDICARE: NEETA KUKREJA M.D.

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	208000000X	Pediatrics Physician	9701800	NC

General Provider Information

NPI Number	:	1801870795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEETA KUKREJA M.D.

Provider Business Mailing Address
First Line	:	1636 LOOKOUT CIR
Second Line	:
City	:	WAXHAW
State	:	NC
Zip	:	28173-8085
Country	:	US
Telephone Number	:	704-540-6860
Fax Number	:

Provider Business Practice Location Address
First Line	:	10410 PARK RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-6568
Country	:	US
Telephone Number	:	704-540-6860
Fax Number	:

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

Provider Enumeration Date	:	12/04/2005
Last Update Date	:	03/20/2011

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