Provider Demographics
NPI:1164499505
Name:KUCHARZYK, DONALD W (DO)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:W
Last Name:KUCHARZYK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7284 W LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-9526
Mailing Address - Country:US
Mailing Address - Phone:219-769-7004
Mailing Address - Fax:219-440-7188
Practice Address - Street 1:7284 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-9526
Practice Address - Country:US
Practice Address - Phone:219-769-7004
Practice Address - Fax:219-440-7188
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001091A207X00000X, 207XS0117X, 207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E05619Medicare UPIN
IN629610AMedicare PIN
IN0545290001Medicare NSC
IN0545290001Medicare NSC