Provider Demographics
NPI:1770698938
Name:KULIK, ANDREW L (DO)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:L
Last Name:KULIK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3446 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103
Mailing Address - Country:US
Mailing Address - Phone:619-295-3470
Mailing Address - Fax:619-295-3495
Practice Address - Street 1:3446 PARK BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:619-295-3470
Practice Address - Fax:619-295-3495
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A4373207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A43730Medicaid
A93576Medicare UPIN
CA20A4373Medicare ID - Type Unspecified