Provider Demographics
NPI:1760602072
Name:SULIK, DAVID (MANAGER)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:SULIK
Suffix:
Gender:M
Credentials:MANAGER
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 72140
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-7340
Mailing Address - Country:US
Mailing Address - Phone:262-375-9610
Mailing Address - Fax:262-375-9608
Practice Address - Street 1:252 N GILBERT ST
Practice Address - Street 2:
Practice Address - City:FOOTVILLE
Practice Address - State:WI
Practice Address - Zip Code:53537
Practice Address - Country:US
Practice Address - Phone:608-876-6118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41350800Medicaid