Provider Demographics
NPI:1841243706
Name:KULAGA, ANDREW D (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:D
Last Name:KULAGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 S BECKHAM AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-4435
Mailing Address - Country:US
Mailing Address - Phone:903-593-0481
Mailing Address - Fax:
Practice Address - Street 1:1726 S BECKHAM AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-4435
Practice Address - Country:US
Practice Address - Phone:903-593-0481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3535207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80P178OtherBLUE CROSS BLUE SHIELD
TX80P178OtherBLUE CROSS BLUE SHIELD
TX80P178Medicare PIN