Healthcare Provider Details

I. General information

NPI: 1164499505
Provider Name (Legal Business Name): DONALD W KUCHARZYK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7284 W LINCOLN HWY
CROWN POINT IN
46307-9526
US

IV. Provider business mailing address

7284 W LINCOLN HWY
CROWN POINT IN
46307-9526
US

V. Phone/Fax

Practice location:
  • Phone: 219-769-7004
  • Fax: 219-440-7188
Mailing address:
  • Phone: 219-769-7004
  • Fax: 219-440-7188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number02001091A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number02001091A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number02001091A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: