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Individual
MR. MARK KUKLEWICZ
Active
Individual
MR. MARK KUKLEWICZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070-005581
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01620328
BCBS
IL
Enumeration date
11/02/2005
Last updated
05/07/2013
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