Provider Demographics
NPI:1255301180
Name:KUKAFKA, DAVID S (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:KUKAFKA
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 1:1900 BOISE AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-5004
Mailing Address - Country:US
Mailing Address - Phone:970-203-2120
Mailing Address - Fax:970-203-2125
Practice Address - Street 1:1900 BOISE AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-5004
Practice Address - Country:US
Practice Address - Phone:970-203-2120
Practice Address - Fax:970-203-2125
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35972207R00000X, 207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01359728Medicaid
CO990006835OtherRAILROAD MEDICARE
COC61258Medicare PIN
COG49283Medicare UPIN
CO01359728Medicaid