MEDICARE: LOUISE HELEN KUKLINSKI MD

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	033333E	PA

General Provider Information

NPI Number	:	1861458150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUISE HELEN KUKLINSKI MD

Provider Business Mailing Address
First Line	:	1244 FT WASHINGTON AVE
Second Line	:	SUITE E2 FAMILY PRACTICE ASSOCIATES OF UPPER DUBLIN
City	:	FT WASHINGTON
State	:	PA
Zip	:	19034
Country	:	US
Telephone Number	:	215-646-1686
Fax Number	:	215-628-4956

Provider Business Practice Location Address
First Line	:	1244 FT WASHINGTON AVE
Second Line	:	SUITE E2 FAMILY PRACTICE ASSOCIATES OF UPPER DUBLIN
City	:	FT WASHINGTON
State	:	PA
Zip	:	19034
Country	:	US
Telephone Number	:	215-646-1686
Fax Number	:	215-628-4956

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

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	03/27/2018

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