Organization
EUN-JUNG P KUCWAY MD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EUN-JUNG P KUCKWAY M.D. (CEO/PRESIDENT)
(248) 765-2892
Entity
Organization
Contact information
Practice address
20755 GREENFIELD RD, SUITE 200, SOUTHFIELD, MI 48075-5403
(248) 765-2892
Mailing address
PO BOX 4416, TROY, MI 48099-4416
(248) 765-2892
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
EK074696
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
EK074696
STATE LICENCE NUMBER
MI
Enumeration date
09/20/2007
Last updated
10/19/2007
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