Individual
TODD G KUKUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3101 BRECKENRIDGE LN, SUITE 1A, LOUISVILLE, KY 40220-2742
(502) 458-7400
(502) 458-7449
Mailing address
3101 BRECKENRIDGE LN, SUITE 1A, LOUISVILLE, KY 40220-2742
(502) 458-7400
(502) 458-7449
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1054875
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000283592
BLUE SHIELD
KY
01
—
1075148
PASSPORT
KY
01
—
2435210000
PASSPORT ADVANTAGE
KY
01
—
430009072
RAILROAD MEDICARE
—
05
—
74383951
—
KY
Enumeration date
10/03/2005
Last updated
06/17/2010
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