Healthcare Provider Details

I. General information

NPI: 1386637635
Provider Name (Legal Business Name): IAN J KUCERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 SW MULVANE ST
TOPEKA KS
66606-1764
US

IV. Provider business mailing address

823 SW MULVANE ST
TOPEKA KS
66606-1764
US

V. Phone/Fax

Practice location:
  • Phone: 785-270-0070
  • Fax:
Mailing address:
  • Phone: 785-270-0070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number04-30570
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number04-30570
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number04-30570
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number04-30570
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: