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General NPI Number Information
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NPI Number | 1912249004
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Entity Type | Individual
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Provider Name | KYLE CHRISTIAN BUKOWSKI MD
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Gender | Male
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Dates
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Enumeration Date | 03/27/2013
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 11500 UNIVERSITY BLVD STE B
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City | ORLANDO
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State | FL
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Zip | 32817-2197
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Country | US
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Telephone | 407-246-1788
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Fax |
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Provider Business Mailing Address
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Address Line | 330 N HOWARD ST
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City | BALTIMORE
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State | MD
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Zip | 21201-3610
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Country | US
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Telephone | 410-949-1185
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME167717
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License Number State | FL
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