Individual
JOHN KUCKELMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9040 JACKSON AVE, JOINT BASE LEWIS MCCHORD, WA 98431-1000
(253) 968-1110
Mailing address
9040 JACKSON AVE, TACOMA, WA 98431-0001
(253) 968-1110
(253) 968-3219
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
92772
GA
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
DO.OP.61502437-IMLC
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/03/2014
Last updated
05/17/2024
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