Provider Demographics
NPI:1417049818
Name:KUCWAY, ROGER T (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:T
Last Name:KUCWAY
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 1:1 SEAGATE # 800
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:734-240-1800
Mailing Address - Fax:419-824-7359
Practice Address - Street 1:800 STEWART RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-4226
Practice Address - Country:US
Practice Address - Phone:734-240-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0901572085R0001X
MI43010700532085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00422855OtherRR MEDICARE
MI5182210Medicaid
MI0N24000017OtherMEDICARE
OH2361386Medicaid
MI5201594OtherMI MEDICAID- OH LOCATIONS
MIP00639054OtherRR MEDICARE
OHKU4212252Medicare PIN
OHP00422855OtherRR MEDICARE
MIH70767Medicare UPIN