Provider Demographics
NPI:1659561835
Name:KUCHLE, NICHOLAS CARL (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:CARL
Last Name:KUCHLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1220 MISSOURI AVE
Mailing Address - Street 2:SUITE 2547
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3725
Mailing Address - Country:US
Mailing Address - Phone:812-283-2635
Mailing Address - Fax:812-283-2236
Practice Address - Street 1:1220 MISSOURI AVE
Practice Address - Street 2:SUITE 2547
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3725
Practice Address - Country:US
Practice Address - Phone:812-283-2635
Practice Address - Fax:812-283-2236
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01069520A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1659561835Medicaid