Healthcare Provider Details

I. General information

NPI: 1699973560
Provider Name (Legal Business Name): LADISLAV KUCHAR DPM, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4810 E HIGHWAY 90
SIERRA VISTA AZ
85635-2440
US

IV. Provider business mailing address

4810 E HIGHWAY 90
SIERRA VISTA AZ
85635-2440
US

V. Phone/Fax

Practice location:
  • Phone: 520-335-8685
  • Fax: 520-335-8705
Mailing address:
  • Phone: 520-335-8685
  • Fax: 520-335-8705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901002173
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number663
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: