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Individual

RADHAKRISHNA KUKKILLAYA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
38 HOSPITAL DR, LOGAN, WV 25601-3452
(304) 792-6282
(304) 792-6290
Mailing address
PO BOX 58187, CHARLESTON, WV 25358-0187
(304) 792-6282
(304) 792-6290

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
18738
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0079677000
WV
Enumeration date
04/14/2006
Last updated
01/24/2014
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