Provider Demographics
NPI:1780868604
Name:KUKHAR, NATALIYA (MD)
Entity Type:Individual
Prefix:
First Name:NATALIYA
Middle Name:
Last Name:KUKHAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6138
Mailing Address - Country:US
Mailing Address - Phone:309-762-9869
Mailing Address - Fax:309-762-2313
Practice Address - Street 1:525 VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6138
Practice Address - Country:US
Practice Address - Phone:309-762-9869
Practice Address - Fax:309-762-2313
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125053616390200000X
IL036124754207Q00000X
IL036.124754390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1780868604Medicaid
ILP01019756OtherRR MEDICARE
IL200715005Medicare PIN