Provider Demographics
NPI:1225039902
Name:KUCHERA, MICHAEL L (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:KUCHERA
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 1:6626 E 75TH ST
Mailing Address - Street 2:STE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:317-621-7584
Mailing Address - Fax:317-957-2705
Practice Address - Street 1:3200 COLD SPRING RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-1960
Practice Address - Country:US
Practice Address - Phone:317-955-6279
Practice Address - Fax:317-955-6287
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS0501240204D00000X
IN02004171A204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201158610Medicaid
INP01424414OtherRAIL ROAD PTAN
PA001929497Medicaid
IN201158610Medicaid
IN266180422Medicare PIN
PA066192K7AMedicare PIN