Individual
ROBERT B KANUCKEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
7709 HOKE RD, ENGLEWOOD, OH 45315-9725
(937) 836-4000
(937) 540-1090
Mailing address
4750 HEMPSTEAD STATION DR, KETTERING, OH 45429-5164
(800) 875-0136
(937) 619-4231
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50000110
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00150614
RR MEDICARE FAIFIELD
—
Enumeration date
05/12/2006
Last updated
04/29/2019
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