Healthcare Provider Details

I. General information

NPI: 1710981170
Provider Name (Legal Business Name): ALEXANDER A KUCEWICZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 04/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 QUEEN CITY AVE
CINCINNATI OH
45238-2316
US

IV. Provider business mailing address

1472 SOLUTIONS CTR
CHICAGO IL
60677-1004
US

V. Phone/Fax

Practice location:
  • Phone: 513-557-3333
  • Fax: 513-557-3203
Mailing address:
  • Phone: 513-557-3333
  • Fax: 513-557-3332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35006215
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: