Healthcare Provider Details

I. General information

NPI: 1700878295
Provider Name (Legal Business Name): PIOTR PAWEL KUKLINSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14641 IRON HORSE WAY
HELOTES TX
78023-3999
US

IV. Provider business mailing address

14641 IRON HORSE WAY
HELOTES TX
78023-3999
US

V. Phone/Fax

Practice location:
  • Phone: 210-978-6498
  • Fax: 210-701-8920
Mailing address:
  • Phone: 210-978-6498
  • Fax: 210-701-8920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM3284
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberM3284
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: