Provider Demographics
NPI:1700076973
Name:SEGOVIA KULIK PSYCHIATRY INC
Entity Type:Organization
Organization Name:SEGOVIA KULIK PSYCHIATRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:KULIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-371-0264
Mailing Address - Street 1:938 W NELSON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6704
Mailing Address - Country:US
Mailing Address - Phone:312-371-0264
Mailing Address - Fax:773-296-3226
Practice Address - Street 1:938 W NELSON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6704
Practice Address - Country:US
Practice Address - Phone:312-371-0264
Practice Address - Fax:773-296-3226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILI19558Medicare UPIN