Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 02004171A | IN |
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | OS0501240 | PA |
NPI | 1225039902 |
---|---|
Provider Name | Michael L. Kuchera |
First Address | Indianapolis, IN 46250-2805 |
Second Address | Indianapolis, IN 46222-1960 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2005 |
Last Update Date | 14/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001929497 | (05) | PA |
201158610 | (05) | IN |
A13419 | (02) | |
P01424414 | RAIL ROAD PTAN (01) | IN |