Provider Demographics
NPI:1932764792
Name:KUCHENTHAL, MICHAEL (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:KUCHENTHAL
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:2701 SW 13TH ST APT D11
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-2069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:444 W BOURNE CIR STE 200
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-3657
Practice Address - Country:US
Practice Address - Phone:801-776-0174
Practice Address - Fax:801-825-3904
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2022-06-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant