Healthcare Provider Details

I. General information

NPI: 1326015041
Provider Name (Legal Business Name): RICHARD A KUCERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 MENTOR AVE SUITE 100
MENTOR OH
44060-8713
US

IV. Provider business mailing address

9500 MENTOR AVE SUITE 100
MENTOR OH
44060-8713
US

V. Phone/Fax

Practice location:
  • Phone: 440-352-4880
  • Fax: 440-352-3629
Mailing address:
  • Phone: 440-352-4880
  • Fax: 440-352-3629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35049005
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: