Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 02001091A | IN |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 02001091A | IN |
N | 207XS0117X | Orthopaedic Spine Surgeon | 02001091A | IN |
NPI | 1164499505 |
---|---|
Provider Name | Donald W Kucharzyk |
First Address | Crown Point, IN 46307-9526 |
Second Address | Crown Point, IN 46307-9526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2006 |
Last Update Date | 11/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E05619 | (02) |