Provider Demographics
NPI:1457336398
Name:KULICK, LEO ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:LEO
Middle Name:ANDREW
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 1:2108 FAREWAY DR
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-4655
Mailing Address - Country:US
Mailing Address - Phone:563-263-0724
Mailing Address - Fax:
Practice Address - Street 1:2108 FAREWAY DR
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-4655
Practice Address - Country:US
Practice Address - Phone:563-263-0724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2009-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26535207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2258921Medicaid
A03596Medicare UPIN
13918Medicare ID - Type Unspecified