Healthcare Provider Details

I. General information

NPI: 1881657880
Provider Name (Legal Business Name): PETER C KUCHARSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 INGALLS DR
HARVEY IL
60426-3558
US

IV. Provider business mailing address

PO BOX 1886
HARVEY IL
60426-7886
US

V. Phone/Fax

Practice location:
  • Phone: 708-331-7800
  • Fax: 708-339-0695
Mailing address:
  • Phone: 708-331-7800
  • Fax: 709-339-0695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: