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1568437507

NPI Code Detail

MEDICARE: SLAVKO KUKUCKA M.D.

MEDICARE: SLAVKO KUKUCKA 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	261QU0200X	Urgent Care Clinic/Center	046877	GA
2	207Q00000X	Family Medicine Physician	046877	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	GRP2837	OTHER	GA	MEDICARE GROUP ID
5	P00441748	OTHER	GA	RR MEDICARE
7	CG4057	OTHER	GA	RR MEDICARE GROUP ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	52782040-008	OTHER	GA	BCBS GA FOR SAVANNAH LOCATION
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	52782040-009	OTHER	GA	BCBS/GA FOR POOLER LOCATION
6	582203199-009	OTHER	GA	TRICARE ID
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	582203199-004	OTHER	GA	TRICARE ID

General Provider Information

NPI Number	:	1568437507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SLAVKO KUKUCKA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 190
Second Line	:
City	:	RINCON
State	:	GA
Zip	:	31326-0190
Country	:	US
Telephone Number	:	912-295-5560
Fax Number	:	912-295-5562

Provider Business Practice Location Address
First Line	:	119 CHIMNEY RD
Second Line	:
City	:	RINCON
State	:	GA
Zip	:	31326-5541
Country	:	US
Telephone Number	:	912-295-5560
Fax Number	:	912-295-5562

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	06/18/2026

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Directions to “ SLAVKO KUKUCKA M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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