Provider Demographics
NPI:1720078587
Name:CUKROWSKI, WALTER J (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:J
Last Name:CUKROWSKI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:29877 TELEGRAPH RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1332
Mailing Address - Country:US
Mailing Address - Phone:248-352-2806
Mailing Address - Fax:248-352-9590
Practice Address - Street 1:29877 TELEGRAPH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1332
Practice Address - Country:US
Practice Address - Phone:248-352-2806
Practice Address - Fax:248-352-9590
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2023-09-28
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Provider Licenses
StateLicense IDTaxonomies
MI4301061442207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5587790001OtherNATIONAL GOVERMENT SERVICES
G75321Medicare UPIN
MIOM36810003Medicare PIN