MEDICARE: RICHARD J KUEKER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	04-19369	KS

General Provider Information

NPI Number	:	1134115215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD J KUEKER MD

Provider Business Mailing Address
First Line	:	PO BOX 325
Second Line	:
City	:	CONCORDIA
State	:	KS
Zip	:	66901-0325
Country	:	US
Telephone Number	:	785-243-1188
Fax Number	:	785-243-1151

Provider Business Practice Location Address
First Line	:	400 W 8TH ST
Second Line	:
City	:	BELOIT
State	:	KS
Zip	:	67420-1605
Country	:	US
Telephone Number	:	785-738-2266
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	07/08/2007

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