Healthcare Provider Details

I. General information

NPI: 1720288509
Provider Name (Legal Business Name): OLGA KUCHMAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 10TH ST E
PALMETTO FL
34221-4131
US

IV. Provider business mailing address

2675 WINKLER AVE FL 2
FORT MYERS FL
33901-9342
US

V. Phone/Fax

Practice location:
  • Phone: 941-933-8103
  • Fax: 941-933-8104
Mailing address:
  • Phone: 941-933-8102
  • Fax: 941-933-8104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101247817
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME117083
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: