Provider Demographics
NPI:1891902151
Name:KULIG, JESSE LAUREN (DO)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:LAUREN
Last Name:KULIG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JESSE
Other - Middle Name:LAUREN
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:1206 E 9TH ST
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-2404
Practice Address - Country:US
Practice Address - Phone:630-967-3470
Practice Address - Fax:630-348-3911
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036119053207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL400480Medicare PIN