Provider Demographics
NPI:1972784833
Name:KULPA, LEROY
Entity Type:Individual
Prefix:
First Name:LEROY
Middle Name:
Last Name:KULPA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8443 WERMUTH
Mailing Address - Street 2:
Mailing Address - City:CENTER LINE
Mailing Address - State:MI
Mailing Address - Zip Code:48015-1747
Mailing Address - Country:US
Mailing Address - Phone:586-945-5798
Mailing Address - Fax:586-510-0607
Practice Address - Street 1:8443 WERMUTH
Practice Address - Street 2:
Practice Address - City:CENTER LINE
Practice Address - State:MI
Practice Address - Zip Code:48015-1747
Practice Address - Country:US
Practice Address - Phone:586-945-5798
Practice Address - Fax:586-510-0607
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501000572237600000X, 332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540E017390OtherBLUE CROSS BLUE SHIELD