Provider Demographics
NPI:1700959830
Name:KUEKES, EDWARD DAVID (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:DAVID
Last Name:KUEKES
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:OKLAHOMA STATE UNIVERSITY-UNIVERSITY COUNSELING CENTER
Mailing Address - Street 2:320 STUDENT UNION
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74078-7051
Mailing Address - Country:US
Mailing Address - Phone:405-744-5458
Mailing Address - Fax:405-744-8380
Practice Address - Street 1:OSU UCS SCC E D KUEKES M D
Practice Address - Street 2:320 STUDENT UNION
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74078-7051
Practice Address - Country:US
Practice Address - Phone:405-744-5458
Practice Address - Fax:405-744-8380
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK218532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKF91420Medicare UPIN
OKWBBGR 249300601Medicare ID - Type Unspecified
OK836017987 249300602Medicare ID - Type Unspecified
OK100163710BMedicaid