MEDICARE: WILLIAM EDWIN KUCHAR 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	207Q00000X	Family Medicine Physician	93-309	NM

General Provider Information

NPI Number	:	1609104074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM EDWIN KUCHAR M.D.

Provider Business Mailing Address
First Line	:	2221 DIETZ PL NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-3109
Country	:	US
Telephone Number	:	505-670-5295
Fax Number	:

Provider Business Practice Location Address
First Line	:	2221 DIETZ PL NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-3109
Country	:	US
Telephone Number	:	505-670-5295
Fax Number	:

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

Provider Enumeration Date	:	11/24/2009
Last Update Date	:	09/10/2015

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