Provider Demographics
NPI:1104843630
Name:KULCZYCKI, ANTHONY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:KULCZYCKI
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:CB 8122
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-454-8917
Mailing Address - Fax:314-454-5140
Practice Address - Street 1:1110 HIGHLANDS PLAZA DR E
Practice Address - Street 2:DIV ALLERGY & IMMUNOLOGY, STE 300
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1392
Practice Address - Country:US
Practice Address - Phone:314-273-5838
Practice Address - Fax:314-273-5839
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-11-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR7229207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200869501Medicaid
IL240170074Medicaid
IL240170074Medicaid
MO081010183Medicaid
MO081010183Medicare PIN