Healthcare Provider Details

I. General information

NPI: 1801892062
Provider Name (Legal Business Name): PAUL A KUCK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 03/28/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 PARK AVE STE A
MARCO ISLAND FL
34145-2750
US

IV. Provider business mailing address

1780 BARBADOS AVE
MARCO ISLAND FL
34145-3864
US

V. Phone/Fax

Practice location:
  • Phone: 239-394-3068
  • Fax: 239-394-1078
Mailing address:
  • Phone: 608-386-0048
  • Fax: 239-394-1078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number153549
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: