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General NPI Number Information
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NPI Number | 1689672040
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Entity Type | Individual
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Provider Name | RICK ALLEN KUKULKA MD
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Gender | Male
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Dates
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Enumeration Date | 07/11/2005
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Last Update Date | 04/29/2022
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Provider Practice Location Address
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Address Line | 5326 SWIFT RIVER CT
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City | BRADENTON
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State | FL
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Zip | 34208-5463
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Country | US
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Telephone | 308-660-5567
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Fax |
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Provider Business Mailing Address
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Address Line | 5326 SWIFT RIVER CT
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City | BRADENTON
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State | FL
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Zip | 34208-5463
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Country | US
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Telephone | 308-660-5567
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 24735
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 35063049
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME 92993
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License Number State | FL
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