Healthcare Provider Details

I. General information

NPI: 1699708552
Provider Name (Legal Business Name): JOSEPH KUCERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 EUCLID AVE STE 403
BERWYN IL
60402-3472
US

IV. Provider business mailing address

2368 PAYSPHERE CIR
CHICAGO IL
60674-2368
US

V. Phone/Fax

Practice location:
  • Phone: 708-783-0700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: