Provider Demographics
NPI:1386770386
Name:KUKULA, CATHY ANN (PA-C)
Entity type:Individual
Prefix:MS
First Name:CATHY
Middle Name:ANN
Last Name:KUKULA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6986 RAWLING DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48094-2488
Mailing Address - Country:US
Mailing Address - Phone:586-258-8206
Mailing Address - Fax:
Practice Address - Street 1:2825 LIVERNOIS RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1214
Practice Address - Country:US
Practice Address - Phone:248-680-2060
Practice Address - Fax:248-680-2099
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI56002120363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP17551Medicare UPIN
MIP17551Medicare UPIN