Provider Demographics
NPI:1720206600
Name:KULICK, DANIEL TIMOTHY (DO)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:TIMOTHY
Last Name:KULICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4472 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROWN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48416-7908
Mailing Address - Country:US
Mailing Address - Phone:810-346-2751
Mailing Address - Fax:
Practice Address - Street 1:4472 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROWN CITY
Practice Address - State:MI
Practice Address - Zip Code:48416-7908
Practice Address - Country:US
Practice Address - Phone:810-346-2751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016234207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5101016234OtherLICENSE
MI5315024530OtherCONTROLLED SUBSTANCE LICENSE
MI11762285OtherCAQH ID
MI1376695205OtherGROUP NPI
MI1376695205OtherGROUP NPI
MIBK9452979OtherDEA
MIBK9452979OtherDEA