Healthcare Provider Details

I. General information

NPI: 1871579938
Provider Name (Legal Business Name): JOHN MICHAEL KUKAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 02/23/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 CHESTNUT COMMONS DR
ELYRIA OH
44035-9607
US

IV. Provider business mailing address

PO BOX 808
NASHUA NH
03061-0808
US

V. Phone/Fax

Practice location:
  • Phone: 440-366-9444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.122487
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: