Provider Demographics
NPI:1487672440
Name:KUKLO, TIMOTHY RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:RAY
Last Name:KUKLO
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 1:4900 S MONACO ST STE 210
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3487
Mailing Address - Country:US
Mailing Address - Phone:303-563-2755
Mailing Address - Fax:303-861-6219
Practice Address - Street 1:1601 E 19TH AVE STE 3800
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1252
Practice Address - Country:US
Practice Address - Phone:303-563-2755
Practice Address - Fax:303-861-6219
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO48576207XS0117X
FL105278207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO68627866Medicaid
CO503421ZLF7Medicare PIN
COA101448Medicare PIN
COP01684054Medicare PIN