Healthcare Provider Details

I. General information

NPI: 1124265731
Provider Name (Legal Business Name): JOHN J KADUKAMMAKAL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2009
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 BREMO RD SUITE 100
RICHMOND VA
23226-2443
US

IV. Provider business mailing address

2008 BREMO RD SUITE 100
RICHMOND VA
23226-2443
US

V. Phone/Fax

Practice location:
  • Phone: 804-285-3933
  • Fax: 804-288-1384
Mailing address:
  • Phone: 804-285-3933
  • Fax: 804-288-1384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC006060
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103301042
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: