Provider Demographics
NPI:1760671119
Name:KUKREJA, TARUN (MD)
Entity Type:Individual
Prefix:
First Name:TARUN
Middle Name:
Last Name:KUKREJA
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 1:1950 45TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3958
Mailing Address - Country:US
Mailing Address - Phone:219-912-3376
Mailing Address - Fax:219-529-6267
Practice Address - Street 1:1950 45TH ST STE 200
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3958
Practice Address - Country:US
Practice Address - Phone:219-912-3376
Practice Address - Fax:219-529-6267
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066709207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200955840Medicaid
IN200955840Medicaid