Most Relevant Information
Provider Data
| NPI Number: | 1003034646 |
| Provider Name: | PATRICIA KUKUSELIS LMT |
| Entity Type: | Individual |
| Taxonomy Code: | 174400000X |
| Specialty: | Specialist |
| License Number: | KY-0140 |
Most Important Dates
| Enumeration Date: | 04/20/2007 |
| Last Updated: | 07/08/2007 |
Provider Practice Location
1506 IDLEWOOD DR
CLARKSVILLE
IN
471291332
Practice Location Phone/Fax
| Phone: | 8129452369 |
| Fax: |
Provider Mailing Location
1506 IDLEWOOD DR
CLARKSVILLE
IN
471291332
Provider Mailing Phone/Fax
| Phone: | 8129452369 |
| Fax: |