Provider Demographics
NPI:1982685046
Name:KULUS, KATHLEEN A (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:KULUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1900 CENTRACARE CIR
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-654-3610
Mailing Address - Fax:320-654-3647
Practice Address - Street 1:1900 CENTRACARE CIR
Practice Address - Street 2:SUITE 1300
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-654-3610
Practice Address - Fax:320-654-3647
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN37889208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
763850OtherARAZ GROUP AMERICAS PPO
110415OtherU CARE
1202265OtherMEDICA HEALTH PLANS
MN159225400Medicaid
1009043OtherPREFERRED ONE
2114177OtherFIRST HEALTH PLAN
COMPOtherONE HEALTH PLAN GREAT WES
COMPOtherMMSI
HP25470OtherHEALTH PARTNERS
COMPOtherCHAMPUS
NEOtherRR MEDICARE
51A36KUOtherBLUE CROSS BLUE SHIELD
SD7713410Medicaid
COMPOtherMMSI
G12362Medicare UPIN