Healthcare Provider Details

I. General information

NPI: 1790753473
Provider Name (Legal Business Name): MICHAEL ALAN KUKFA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 HAGEN DR SUITE 350
ROCHESTER NY
14625-2660
US

IV. Provider business mailing address

10 HAGEN DR SUITE 350
ROCHESTER NY
14625-2660
US

V. Phone/Fax

Practice location:
  • Phone: 585-385-5555
  • Fax: 585-385-5611
Mailing address:
  • Phone: 585-385-5555
  • Fax: 585-385-5611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number175129
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: