Provider Demographics
NPI:1851725410
Name:KULISZ, ANDRE ALEXANDER (PHD, ND, ACN)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:ALEXANDER
Last Name:KULISZ
Suffix:
Gender:M
Credentials:PHD, ND, ACN
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 63794
Mailing Address - Street 2:
Mailing Address - City:PIPE CREEK
Mailing Address - State:TX
Mailing Address - Zip Code:78063-3794
Mailing Address - Country:US
Mailing Address - Phone:918-398-0252
Mailing Address - Fax:661-459-2329
Practice Address - Street 1:1647 RIO RANCHERO
Practice Address - Street 2:
Practice Address - City:LAKEHILLS
Practice Address - State:TX
Practice Address - Zip Code:78063-6090
Practice Address - Country:US
Practice Address - Phone:918-398-0252
Practice Address - Fax:661-459-2329
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNOT REGULATED IN TX175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath