MEDICARE: DR. DANE KENT WUKICH M.D.

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	174400000X	Specialist	R0524	TX
2	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician	R0524	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184690489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANE KENT WUKICH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 845347
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-5347
Country	:	US
Telephone Number	:	214-266-2600
Fax Number	:	214-590-2773

Provider Business Practice Location Address
First Line	:	1801 INWOOD RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-8883
Country	:	US
Telephone Number	:	214-645-3300
Fax Number	:	294-645-3301

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

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	05/10/2017

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