Provider Demographics
NPI:1295709533
Name:KULIK, KENNETH J (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:J
Last Name:KULIK
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 1:44199 DEQUINDRE
Mailing Address - Street 2:STE 503
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085
Mailing Address - Country:US
Mailing Address - Phone:248-879-2322
Mailing Address - Fax:248-879-2365
Practice Address - Street 1:44199 DEQUINDRE
Practice Address - Street 2:STE 503
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085
Practice Address - Country:US
Practice Address - Phone:248-879-2322
Practice Address - Fax:248-897-2365
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301042847207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI322087710Medicaid
E26250Medicare UPIN
OM12070003Medicare ID - Type Unspecified
ON61420Medicare Oscar/Certification