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General NPI Number Information
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NPI Number | 1376739664
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Entity Type | Organization
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Legal Business Name | EUN-JUNG P KUCWAY MD PLLC
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Dates
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Enumeration Date | 09/20/2007
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Last Update Date | 10/19/2007
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Provider Practice Location Address
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Address Line | 20755 GREENFIELD RD SUITE 200
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City | SOUTHFIELD
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State | MI
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Zip | 48075-5403
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Country | US
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Telephone | 248-765-2892
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4416
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City | TROY
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State | MI
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Zip | 48099-4416
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Country | US
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Telephone | 248-765-2892
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | DR. EUN-JUNG P KUCKWAY
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Credential | M.D.
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Telephone | 248-765-2892
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | EK074696
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License Number State | MI
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