Provider Demographics
NPI:1942303250
Name:PUCA, KATHLEEN E (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:E
Last Name:PUCA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8085 RIVERS AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9239
Mailing Address - Country:US
Mailing Address - Phone:843-569-8495
Mailing Address - Fax:770-237-4971
Practice Address - Street 1:638 N 18TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-2121
Practice Address - Country:US
Practice Address - Phone:414-937-6350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44845020207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H74940Medicare UPIN