Provider Demographics
NPI:1306994520
Name:WUKASCH, DON CHARLES (MD,FACS,FACC,FACCP)
Entity type:Individual
Prefix:DR
First Name:DON
Middle Name:CHARLES
Last Name:WUKASCH
Suffix:
Gender:M
Credentials:MD,FACS,FACC,FACCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1229
Mailing Address - Country:US
Mailing Address - Phone:713-256-1133
Mailing Address - Fax:512-472-4701
Practice Address - Street 1:92 MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-1499
Practice Address - Country:US
Practice Address - Phone:413-527-1167
Practice Address - Fax:512-472-4701
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD0356103TP0814X, 208600000X, 2084P0800X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA231167OtherMEDICAL STATE LICENSE NUMBER
TXD 0356OtherMEDICAL LICENSE NUMBER
TXK0016291OtherCON TROLLED SUBSTANCE REGISTRATION
MAMW0858766AOtherCON TROLLED SUBSTANCE REGISTRATION
TXD 0356OtherMEDICAL LICENSE NUMBER