Healthcare Provider Details

I. General information

NPI: 1245664069
Provider Name (Legal Business Name): CHRISTOPHER R KUCAN CST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 W HIGGINS RD
SCHAUMBURG IL
60195-3203
US

IV. Provider business mailing address

929 W HIGGINS RD
SCHAUMBURG IL
60195-3203
US

V. Phone/Fax

Practice location:
  • Phone: 847-285-4200
  • Fax: 847-885-0130
Mailing address:
  • Phone: 847-285-4200
  • Fax: 847-885-0130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number237000125
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: