Provider Demographics
NPI:1942285242
Name:CUCKA, MICHAEL E (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:E
Last Name:CUCKA
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 1:641 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-4068
Mailing Address - Country:US
Mailing Address - Phone:860-582-6603
Mailing Address - Fax:860-585-9245
Practice Address - Street 1:641 CLARK AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4068
Practice Address - Country:US
Practice Address - Phone:860-582-6603
Practice Address - Fax:860-585-9245
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032941207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORO2017OtherHEALTHNET
HAS706OtherOXFORD
CT010032941CT01OtherANTHEM BC BS
CT750048OtherCONNECTICARE
HAS706OtherOXFORD
CT200000724E0791Medicare ID - Type Unspecified