Healthcare Provider Details

I. General information

NPI: 1215041348
Provider Name (Legal Business Name): MICHAEL WARREN KUCHERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E HANOVER AVE SUITE 101
CEDAR KNOLLS NJ
07927-2000
US

IV. Provider business mailing address

PO BOX 1368
MORRISTOWN NJ
07962-1368
US

V. Phone/Fax

Practice location:
  • Phone: 973-605-5090
  • Fax: 973-605-1705
Mailing address:
  • Phone: 973-605-5090
  • Fax: 973-605-1705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA05645700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: