Provider Demographics
NPI:1184690489
Name:WUKICH, DANE KENT (MD)
Entity Type:Individual
Prefix:DR
First Name:DANE
Middle Name:KENT
Last Name:WUKICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-266-2600
Mailing Address - Fax:214-590-2773
Practice Address - Street 1:1801 INWOOD RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-8883
Practice Address - Country:US
Practice Address - Phone:214-645-3300
Practice Address - Fax:294-645-3301
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR0524174400000X, 207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001239430Medicaid
TX001239430Medicaid
PA001239430Medicaid