Provider Demographics
NPI:1255545547
Name:KULICK, JOHN ALAN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ALAN
Last Name:KULICK
Suffix:
Gender:M
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:PO BOX 273606
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33427-3606
Mailing Address - Country:US
Mailing Address - Phone:561-750-0924
Mailing Address - Fax:
Practice Address - Street 1:22804 MARBELLA CIRCLE
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3802
Practice Address - Country:US
Practice Address - Phone:561-750-0924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0041506207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D63779Medicare UPIN
FL96220Medicare ID - Type Unspecified