Provider Demographics
NPI:1639412000
Name:KUCHINKA, SAM N (MD)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:N
Last Name:KUCHINKA
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:MEMORIAL MEDICAL CENTER
Mailing Address - Street 2:1615 MAPLE LANE
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806
Mailing Address - Country:US
Mailing Address - Phone:715-685-5500
Mailing Address - Fax:715-682-4022
Practice Address - Street 1:MEMORIAL MEDICAL CENTER
Practice Address - Street 2:1615 MAPLE LANE
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806
Practice Address - Country:US
Practice Address - Phone:715-685-5500
Practice Address - Fax:715-682-4022
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI66857-20207W00000X
390200000X
WI66857207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program