Provider Demographics
NPI:1710986427
Name:KUKIELKA, GILBERT L (MD)
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:L
Last Name:KUKIELKA
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:PO BOX 801143
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-1143
Mailing Address - Country:US
Mailing Address - Phone:573-331-5583
Mailing Address - Fax:573-331-5079
Practice Address - Street 1:211 SAINT FRANCIS DR STE 15
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5049
Practice Address - Country:US
Practice Address - Phone:573-331-3333
Practice Address - Fax:573-331-3334
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020012709207RC0000X, 207RI0011X
OH35077124207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2159962Medicaid
WV1802669000Medicaid
OHP01060288OtherRAILROAD MEDICARE
OHP01184282OtherRAILROAD MEDICARE - MMH
OHH087820Medicare PIN
OHP01184282OtherRAILROAD MEDICARE - MMH
OHP01060288OtherRAILROAD MEDICARE
WV1802669000Medicaid