Individual
IVAN STUKALAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10 MEMBERS WAY FL 5, DOVER, NH 03820-5933
(603) 609-6800
Mailing address
PO BOX 412503, BOSTON, MA 02241-1784
(617) 643-8315
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
24526
NH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/10/2021
Last updated
07/02/2024
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