Healthcare Provider Details

I. General information

NPI: 1861985244
Provider Name (Legal Business Name): ZACHARY KUCHAREK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3097 29TH ST SE STE B
GRAND RAPIDS MI
49512-1726
US

IV. Provider business mailing address

PO BOX 561564
DENVER CO
80256-1564
US

V. Phone/Fax

Practice location:
  • Phone: 616-741-2232
  • Fax:
Mailing address:
  • Phone: 616-741-2232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501018673
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: