Healthcare Provider Details

I. General information

NPI: 1225342751
Provider Name (Legal Business Name): JOSEPH MATTHEW KUKLA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3047 CENTER POINT RD NE STE A
CEDAR RAPIDS IA
52402-4064
US

IV. Provider business mailing address

3047 CENTER POINT RD NE STE A
CEDAR RAPIDS IA
52402-4064
US

V. Phone/Fax

Practice location:
  • Phone: 319-365-6973
  • Fax: 319-365-6974
Mailing address:
  • Phone: 319-365-6973
  • Fax: 319-365-6974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000885
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3496
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: