Basic Information
| Provider Information | |||||||||
| NPI: | 1386821734 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUKREJA | ||||||||
| FirstName: | MARCIA | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6720 BERTNER AVE | ||||||||
| Address2: | MC2-270 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770302604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8323554092 | ||||||||
| FaxNumber: | 8323552591 | ||||||||
| Practice Location | |||||||||
| Address1: | 3333 BURNET AVE | ||||||||
| Address2: | RADIOLOGY ML 5031 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452293039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136364251 | ||||||||
| FaxNumber: | 5136368145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2008 | ||||||||
| LastUpdateDate: | 04/14/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085P0229X | 35.094695 | OH | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085R0202X | 44538 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085P0229X | 44538 | TX | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology |
No ID Information.