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General NPI Number Information
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NPI Number | 1437974730
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Entity Type | Individual
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Provider Name | STEPHEN KUCLO IHP L2, HPH, EMT-P
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Gender | Male
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Dates
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Enumeration Date | 11/21/2024
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 16633 DALLAS PKWY STE 150
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City | ADDISON
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State | TX
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Zip | 75001-6812
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Country | US
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Telephone | 469-999-6985
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Fax |
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Provider Business Mailing Address
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Address Line | 4109 REPUBLICAN BRANCH DR
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City | PROSPER
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State | TX
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Zip | 75078-9825
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Country | US
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Telephone | 469-999-6985
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Fax |
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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 | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 276794406
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License Number State | TX
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