Healthcare Provider Details

I. General information

NPI: 1467803718
Provider Name (Legal Business Name): YEKATERINA KUCHEROV MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: YEKATERINA KUCEROVA

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N SENATE BLVD
INDIANAPOLIS IN
46202-1239
US

IV. Provider business mailing address

950 W WALNUT ST # E124
INDIANAPOLIS IN
46202-5188
US

V. Phone/Fax

Practice location:
  • Phone: 317-962-6793
  • Fax:
Mailing address:
  • Phone: 317-274-0010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number01093007A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01093007A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: