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NPI Code Detail

MEDICARE: JOHN R KUKSA P.A.

MEDICARE: JOHN R KUKSA P.A.
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
1363A00000XPhysician Assistant5601001196MI

General Provider Information

NPI Number : 1497876791
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN R KUKSA P.A.
Provider Business Mailing Address
First Line : 5080 SPECTRUM DR
Second Line : SUITE 1200 WEST
City : ADDISON
State : TX
Zip : 75001-4648
Country : US
Telephone Number : 972-364-8000
Fax Number :
Provider Business Practice Location Address
First Line : 1915 N PERRY ST
Second Line :
City : PONTIAC
State : MI
Zip : 48340-2237
Country : US
Telephone Number : 615-778-4066
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2007
Last Update Date : 06/30/2009

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