Healthcare Provider Details

I. General information

NPI: 1760671119
Provider Name (Legal Business Name): TARUN KUKREJA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 45TH ST STE 200
MUNSTER IN
46321-3958
US

IV. Provider business mailing address

1950 45TH ST STE 200
MUNSTER IN
46321-3958
US

V. Phone/Fax

Practice location:
  • Phone: 219-912-3376
  • Fax: 219-529-6267
Mailing address:
  • Phone: 219-912-3376
  • Fax: 219-529-6267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number01066709
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: