Healthcare Provider Details

I. General information

NPI: 1447393335
Provider Name (Legal Business Name): THOMAS E KUICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1965 S FREMONT AVE SUITE 330
SPRINGFIELD MO
65804-2201
US

IV. Provider business mailing address

PO BOX 2580
SPRINGFIELD MO
65801-2580
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-8180
  • Fax: 417-820-8183
Mailing address:
  • Phone: 417-829-4620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2000158321
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: