Individual
BRIAN PATRICK KUKLOK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1015 NW 22ND AVE, PORTLAND, OR 97210-3025
(503) 413-8401
(503) 413-7361
Mailing address
1015 NW 22ND AVE, PORTLAND, OR 97210-3025
(503) 413-8401
(503) 413-7361
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
06/26/2018
Last updated
04/08/2019
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