Individual
CRYSTAL KUCUK MACOMB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 798-8400
Mailing address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0102206099
VA
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
4621
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/11/2017
Last updated
09/16/2022
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