Provider Demographics
NPI:1346256021
Name:KULOW, KENT (PA-C)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:
Last Name:KULOW
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20800 HARVARD RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HIGHLAND HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7249
Mailing Address - Country:US
Mailing Address - Phone:216-383-0100
Mailing Address - Fax:
Practice Address - Street 1:3909 ORANGE PL
Practice Address - Street 2:SUITE 2100
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4478
Practice Address - Country:US
Practice Address - Phone:216-896-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50001232363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant