Pucek, Kelly D

Pucek, Kelly D is an individual health care provider with primary practice located at 24 Physicians Dr , Jackson TN 38305-2070. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Orthopaedic Surgery, Allopathic & Osteopathic Physicians / Sports Medicine. Allopathic & Osteopathic Physicians / Orthopaedic Surgery is his primary health care specialty. Pucek, Kelly D can be contacted via phone (731) 661-9825.

Contact Information

Primary practice address
24 Physicians Dr Jackson TN 38305-2070
Phone: (731) 661-9825
Fax: (731) 668-6757
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X MD30606 Tennessee
Allopathic & Osteopathic Physicians / Sports Medicine 207XX0005X MD30606 Tennessee

Profile Details

NPI number 1710086335
LBN Legal business name Pucek, Kelly D
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 21st, 2006
Last updated Nov 2nd, 2015 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1710086335 NPPES
Tennessee MEDICAID Q010037

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