MEDICARE: DR. NICHOLAS PAUL KUCINSKI D.O.

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	207Q00000X	Family Medicine Physician	006440	AZ
2	207Q00000X	Family Medicine Physician	R73472	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R73472	OTHER	AZ	TRAINING PERMIT

General Provider Information

NPI Number	:	1477817450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS PAUL KUCINSKI D.O.

Provider Business Mailing Address
First Line	:	2500 W UTOPIA RD
Second Line	:	SUITE 100
City	:	PHOENIX
State	:	AZ
Zip	:	85027-4171
Country	:	US
Telephone Number	:	623-434-6200
Fax Number	:	623-434-6164

Provider Business Practice Location Address
First Line	:	10230 W HAPPY VALLEY PKWY
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85383-4691
Country	:	US
Telephone Number	:	623-561-3030
Fax Number	:	623-825-5630

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

Provider Enumeration Date	:	06/25/2012
Last Update Date	:	08/24/2023

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Directions to “ DR. NICHOLAS PAUL KUCINSKI D.O.” Practice Location

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