Basic Information
| Provider Information | |||||||||
| NPI: | 1255301180 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUKAFKA | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 BOISE AVE | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805385004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702032120 | ||||||||
| FaxNumber: | 9702032125 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 BOISE AVE | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805385004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702032120 | ||||||||
| FaxNumber: | 9702032125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2006 | ||||||||
| LastUpdateDate: | 02/05/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35972 | CO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | 35972 | CO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 35972 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RS0012X | 35972 | CO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01359728 | 05 | CO | MEDICAID | 990006835 | 01 | CO | RAILROAD MEDICARE | OTHER |