Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 52890-20 | WI |
NPI | 1033371745 |
---|---|
Provider Name | Dr. Christopher J Kucharski |
First Address | Wausau, WI 54403-4754 |
Second Address | Wausau, WI 54403-4754 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2008 |
Last Update Date | 07/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100004229 | (05) | WI |
391550037 | MEDICARE (01) | WI |
52890 | WI MEDICAL LICENSE (01) | WI |