Individual
MICHAEL LAMAR KUKULKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1355 W BLOOMFIELD RD STE 3, BLOOMINGTON, IN 47403-2051
(812) 200-2789
Mailing address
2602 GLACIER ST, ANCHORAGE, AK 99508-3772
(907) 843-1664
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
195749
AK
363LF0000X
Family Nurse Practitioner
Primary
71009326A
IN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
71009326A
IN
Other
Enumeration date
09/06/2019
Last updated
08/02/2023
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