Provider Demographics
NPI:1922051499
Name:KUCERA, TODD ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:ALLEN
Last Name:KUCERA
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 539
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:IA
Mailing Address - Zip Code:50801-0539
Mailing Address - Country:US
Mailing Address - Phone:641-782-5052
Mailing Address - Fax:641-782-5721
Practice Address - Street 1:1700 W TOWNLINE ST
Practice Address - Street 2:
Practice Address - City:CRESTON
Practice Address - State:IA
Practice Address - Zip Code:50801-1054
Practice Address - Country:US
Practice Address - Phone:641-782-7091
Practice Address - Fax:641-782-5721
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA239282085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
300036076OtherRR MEDICARE
IA1922051499Medicaid
300036076OtherRR MEDICARE
A02800Medicare UPIN