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NPI Code Detail

MEDICARE: TODD G KUKUCK CRNA

MEDICARE: TODD G KUKUCK CRNA
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
1367500000XCertified Registered Nurse Anesthetist1054875KY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2430009072OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12435210000OTHERKYPASSPORT ADVANTAGE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
41075148OTHERKYPASSPORT
5000000283592OTHERKYBLUE SHIELD

General Provider Information

NPI Number : 1558358762
Entity Type Code : Individual
Provider Name (Legal Business Name) : TODD G KUKUCK CRNA
Provider Business Mailing Address
First Line : 3101 BRECKENRIDGE LN
Second Line : SUITE 1A
City : LOUISVILLE
State : KY
Zip : 40220-2742
Country : US
Telephone Number : 502-458-7400
Fax Number : 502-458-7449
Provider Business Practice Location Address
First Line : 3101 BRECKENRIDGE LN
Second Line : SUITE 1A
City : LOUISVILLE
State : KY
Zip : 40220-2742
Country : US
Telephone Number : 502-458-7400
Fax Number : 502-458-7449
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2005
Last Update Date : 06/17/2010

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