Provider Demographics
NPI:1700612306
Name:KUCERAK, DANIEL WILLIAM II
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:WILLIAM
Last Name:KUCERAK
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-9157
Mailing Address - Country:US
Mailing Address - Phone:269-447-9831
Mailing Address - Fax:
Practice Address - Street 1:1221 M 89
Practice Address - Street 2:
Practice Address - City:PLAINWELL
Practice Address - State:MI
Practice Address - Zip Code:49080-1180
Practice Address - Country:US
Practice Address - Phone:269-680-3710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant