Provider Demographics
NPI:1417119918
Name:KUKKAR, NITIN (MD)
Entity Type:Individual
Prefix:
First Name:NITIN
Middle Name:
Last Name:KUKKAR
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 1:1806 AYLETH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-3975
Mailing Address - Country:US
Mailing Address - Phone:210-401-1515
Mailing Address - Fax:210-401-1818
Practice Address - Street 1:7410 BLANCO RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4364
Practice Address - Country:US
Practice Address - Phone:210-401-1515
Practice Address - Fax:210-401-1818
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01076443A207X00000X
MAL-235563207X00000X
IL036128840207X00000X
TXQ7908207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036128840Medicaid
IL256510127Medicare PIN