Provider Demographics
NPI:1366493991
Name:KUKLA, LAWRENCE JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:JOSEPH
Last Name:KUKLA
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 1:150 MERCY DR
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-7301
Mailing Address - Country:US
Mailing Address - Phone:563-584-3480
Mailing Address - Fax:563-584-3481
Practice Address - Street 1:150 MERCY DR
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-7301
Practice Address - Country:US
Practice Address - Phone:563-584-3480
Practice Address - Fax:563-584-3481
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI26579207RH0003X
IA036-05398207RH0003X
IA24645207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0223347Medicaid
A02584Medicare UPIN