Provider Demographics
NPI:1366931644
Name:KUCA, IRENA (MD)
Entity type:Individual
Prefix:
First Name:IRENA
Middle Name:
Last Name:KUCA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 AERIAL WAY
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-9757
Mailing Address - Country:US
Mailing Address - Phone:541-687-6353
Mailing Address - Fax:541-242-8430
Practice Address - Street 1:4545 CORDATA PKWY STE 2C
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-7264
Practice Address - Country:US
Practice Address - Phone:360-752-5165
Practice Address - Fax:360-752-5686
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD202354207Q00000X
WAMD61560853207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine