Healthcare Provider Details

I. General information

NPI: 1871705699
Provider Name (Legal Business Name): MICHAEL JAMES KUCENIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 SW WANAMAKER DR
TOPEKA KS
66614-5328
US

IV. Provider business mailing address

2200 SW 6TH AVE STE 104
TOPEKA KS
66606-1707
US

V. Phone/Fax

Practice location:
  • Phone: 785-272-6860
  • Fax: 785-272-5839
Mailing address:
  • Phone: 785-354-8518
  • Fax: 785-354-1255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0431214
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number04-31214
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number04-31214
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number2020000004
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number01062202A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: