Healthcare Provider Details

I. General information

NPI: 1306053020
Provider Name (Legal Business Name): STEPHEN THOMAS KUCERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 12/19/2019
Certification Date: 12/19/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 ARLINGTON ST STE 101
SARASOTA FL
34239-3508
US

IV. Provider business mailing address

PO BOX 863407
ORLANDO FL
32886-3407
US

V. Phone/Fax

Practice location:
  • Phone: 941-262-0400
  • Fax: 941-262-0410
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME97935
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: