| Doctor Name: | JACEK M KUCHAREWICZ |
| NPI Number: | 1437438710 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | TRAINING LICENSE |
| Business Practice Address: | 809 82nd Pkwy Myrtle Beach, SC - 295724607 |
| Business Phone Number: | 8434972959 |
| Business Fax Number: | 8438394448 |
| Mailing Address: | 4615 Oleander Dr, Suite 201a MYRTLE BEACH |
| State: | SC |
| Postal Code: | 295775741 |
| Phone Number: | 8434975929 |
| Fax Number: | 8438394448 |
| NPI Enumeration Date: | 08/04/2011 |
| NPI Last Update Date: | 11/25/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | TRAINING LICENSE |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NJ |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |