Provider Demographics
NPI:1750670279
Name:CUKA, NATHAN SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:SAMUEL
Last Name:CUKA
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 1:600 CHESTER RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-1704
Mailing Address - Country:US
Mailing Address - Phone:773-368-5035
Mailing Address - Fax:336-999-8889
Practice Address - Street 1:3333 SILAS CREEK PKWY FL 1
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3013
Practice Address - Country:US
Practice Address - Phone:336-718-5856
Practice Address - Fax:336-999-8889
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201601042207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1750670279Medicaid