Provider Demographics
NPI:1700958907
Name:GULICK, CHARLES RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:RICHARD
Last Name:GULICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:STE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:314-725-9300
Mailing Address - Fax:314-725-4662
Practice Address - Street 1:9450 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-1452
Practice Address - Country:US
Practice Address - Phone:314-725-9300
Practice Address - Fax:314-725-4662
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO34749207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4122OtherBCBS
161803838OtherRAILROAD MEDICARE
161803838OtherRAILROAD MEDICARE
MOA24537Medicare UPIN