Individual
TAMMY M KUCIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C
Contact information
Practice address
2300 N ROCKTON AVE, ROCKFORD, IL 61103-3619
(815) 971-2000
Mailing address
2300 N ROCKTON AVE, ROCKFORD, IL 61103-3619
(815) 971-2000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085-002416
IL
363AM0700X
Medical Physician Assistant
Primary
085002416
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00626529
RR MEDICARE
IL
Enumeration date
08/31/2006
Last updated
06/17/2015
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