Provider Demographics
NPI:1578277554
Name:KULIBERT, SIMONE ERICH
Entity Type:Individual
Prefix:MR
First Name:SIMONE
Middle Name:ERICH
Last Name:KULIBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51ST MEDICAL GROUP, 777 SONGTAN BOULEVARD, UNIT 2060
Mailing Address - Street 2:OSAN AIR BASE
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96278-2060
Mailing Address - Country:US
Mailing Address - Phone:315-784-2108
Mailing Address - Fax:
Practice Address - Street 1:51ST MEDICAL GROUP, 777 SONGTAN BOULEVARD, UNIT 2060
Practice Address - Street 2:OSAN AIR BASE
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96278-2060
Practice Address - Country:US
Practice Address - Phone:315-784-2108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician