Healthcare Provider Details

I. General information

NPI: 1659766277
Provider Name (Legal Business Name): BRANDON KUCHTA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8905 W LINCOLN AVE STE 501
WEST ALLIS WI
53227-2470
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 414-978-2229
  • Fax:
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number71311
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: