Basic Information
| Provider Information | |||||||||
| NPI: | 1639412000 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | KUCHINKA | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | N. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | MEMORIAL MEDICAL CENTER | ||||||||
| Address2: | 1615 MAPLE LANE | ||||||||
| City: | ASHLAND | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7156855500 | ||||||||
| FaxNumber: | 7156824022 | ||||||||
| Practice Location | |||||||||
| Address1: | MEMORIAL MEDICAL CENTER | ||||||||
| Address2: | 1615 MAPLE LANE | ||||||||
| City: | ASHLAND | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7156855500 | ||||||||
| FaxNumber: | 7156824022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2013 | ||||||||
| LastUpdateDate: | 10/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 66857-20 | WI | N | Allopathic & Osteopathic Physicians | Ophthalmology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207W00000X | 66857 | WI | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.