Healthcare Provider Details

I. General information

NPI: 1700612306
Provider Name (Legal Business Name): MR. DANIEL WILLIAM KUCERAK II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 M 89
PLAINWELL MI
49080-1180
US

IV. Provider business mailing address

1750 N 10TH ST
KALAMAZOO MI
49009-9157
US

V. Phone/Fax

Practice location:
  • Phone: 269-680-3710
  • Fax:
Mailing address:
  • Phone: 269-447-9831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: