Provider Demographics
NPI:1487664918
Name:INTERNAL MEDICINE ASSOCIATES OF PUEBLO P.C.
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF PUEBLO P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:KULIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-545-5297
Mailing Address - Street 1:1619 N GREENWOOD ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2644
Mailing Address - Country:US
Mailing Address - Phone:719-545-5297
Mailing Address - Fax:719-583-9682
Practice Address - Street 1:1619 N GREENWOOD ST
Practice Address - Street 2:SUITE 106
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2644
Practice Address - Country:US
Practice Address - Phone:719-545-5297
Practice Address - Fax:719-583-9682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26132207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0126132Medicaid
COCG8408Medicare Oscar/Certification
E75708Medicare UPIN