Healthcare Provider Details

I. General information

NPI: 1225039902
Provider Name (Legal Business Name): MICHAEL L. KUCHERA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 04/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 COLD SPRING RD
INDIANAPOLIS IN
46222-1960
US

IV. Provider business mailing address

6626 E 75TH ST STE 500
INDIANAPOLIS IN
46250-2805
US

V. Phone/Fax

Practice location:
  • Phone: 317-955-6279
  • Fax: 317-955-6287
Mailing address:
  • Phone: 317-621-7584
  • Fax: 317-957-2705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberOS0501240
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number02004171A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: