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General NPI Number Information
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NPI Number | 1366787053
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Entity Type | Individual
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Provider Name | ROBERT KUCEJKO M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/06/2012
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Last Update Date | 04/26/2023
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Provider Practice Location Address
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Address Line | 2221 STOCKTON BLVD STE E
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City | SACRAMENTO
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State | CA
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Zip | 95817-1418
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Country | US
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Telephone | 916-734-2680
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Fax |
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Provider Business Mailing Address
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Address Line | 2335 STOCKTON BLVD. NAOB 6TH FLOOR
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City | WEST SACRAMENTO
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State | CA
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Zip | 95617
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Country | US
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Telephone | 916-734-9031
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Fax | 916-703-4452
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A178559
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License Number State | CA
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