Healthcare Provider Details

I. General information

NPI: 1417049818
Provider Name (Legal Business Name): ROGER T KUCWAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 STEWART RD
MONROE MI
48162-4226
US

IV. Provider business mailing address

1 SEAGATE # 800
TOLEDO OH
43604-1558
US

V. Phone/Fax

Practice location:
  • Phone: 734-240-1800
  • Fax:
Mailing address:
  • Phone: 734-240-1800
  • Fax: 419-824-7359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number35.090157
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number4301070053
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: