Healthcare Provider Details

I. General information

NPI: 1033371745
Provider Name (Legal Business Name): CHRISTOPHER J KUCHARSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N 1ST ST
WAUSAU WI
54403-4754
US

IV. Provider business mailing address

800 N 1ST ST
WAUSAU WI
54403-4754
US

V. Phone/Fax

Practice location:
  • Phone: 715-261-8500
  • Fax: 715-261-8667
Mailing address:
  • Phone: 715-261-8500
  • Fax: 715-261-8667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number52890-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: