Provider Demographics
NPI:1679948459
Name:KULEZIC, VERA (LAC)
Entity Type:Individual
Prefix:
First Name:VERA
Middle Name:
Last Name:KULEZIC
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6015 N NINA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-2411
Mailing Address - Country:US
Mailing Address - Phone:773-775-4257
Mailing Address - Fax:773-775-4845
Practice Address - Street 1:6015 N NINA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-2411
Practice Address - Country:US
Practice Address - Phone:773-775-4257
Practice Address - Fax:773-775-4845
Is Sole Proprietor?:No
Enumeration Date:2015-12-05
Last Update Date:2015-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.000871171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist