Healthcare Provider Details

I. General information

NPI: 1124290002
Provider Name (Legal Business Name): STEPHEN FRANCIS KUCERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3248 DOGWOOD DR
BINGHAMTON NY
13903-3111
US

IV. Provider business mailing address

3248 DOGWOOD DR
BINGHAMTON NY
13903-3111
US

V. Phone/Fax

Practice location:
  • Phone: 607-722-9352
  • Fax:
Mailing address:
  • Phone: 607-722-9352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number095007-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: