Healthcare Provider Details

I. General information

NPI: 1982587226
Provider Name (Legal Business Name): MICHAEL J KUCERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2025
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 N 101ST ST
LINCOLN NE
68527-3714
US

IV. Provider business mailing address

1131 N 101ST ST
LINCOLN NE
68527-3714
US

V. Phone/Fax

Practice location:
  • Phone: 402-417-4597
  • Fax:
Mailing address:
  • Phone: 402-417-4597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: