Provider Demographics
NPI:1386648954
Name:KULA, ZBIGNIEW JAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ZBIGNIEW
Middle Name:JAN
Last Name:KULA
Suffix:
Gender:M
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:PO BOX H
Mailing Address - Street 2:
Mailing Address - City:CROSSETT
Mailing Address - State:AR
Mailing Address - Zip Code:71635-1808
Mailing Address - Country:US
Mailing Address - Phone:870-364-3474
Mailing Address - Fax:870-304-2156
Practice Address - Street 1:1003 FRED LAGRONE DR
Practice Address - Street 2:
Practice Address - City:CROSSETT
Practice Address - State:AR
Practice Address - Zip Code:71635-4546
Practice Address - Country:US
Practice Address - Phone:870-364-3474
Practice Address - Fax:870-364-3811
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2439207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR139166001Medicaid
5U594OtherMEDICARE PTAN
AR139166001Medicaid