Provider Demographics
NPI:1891743480
Name:KROUPA-KULIK, MICHELLE R (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:KROUPA-KULIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 SANDPOINT RD
Mailing Address - Street 2:
Mailing Address - City:MUNISING
Mailing Address - State:MI
Mailing Address - Zip Code:49862-1406
Mailing Address - Country:US
Mailing Address - Phone:906-387-4338
Mailing Address - Fax:906-387-2825
Practice Address - Street 1:1500 SANDPOINT RD
Practice Address - Street 2:
Practice Address - City:MUNISING
Practice Address - State:MI
Practice Address - Zip Code:49862-1406
Practice Address - Country:US
Practice Address - Phone:906-387-4338
Practice Address - Fax:906-387-2825
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068824207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI774301871Medicaid
MI23-8650OtherRHC CERTIFICATION NUMBER (CMS)
MI080A760010OtherBCBS
MI080A760010OtherBCBS