Provider Demographics
NPI:1114734472
Name:KUJATH, RICHARD EDWARD
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:EDWARD
Last Name:KUJATH
Suffix:
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 1:287 N 115TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2520
Mailing Address - Country:US
Mailing Address - Phone:402-502-5352
Mailing Address - Fax:
Practice Address - Street 1:287 N 115TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2520
Practice Address - Country:US
Practice Address - Phone:402-502-5352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion