Provider Demographics
NPI:1841453909
Name:KULIK-CARLOS, ANNA (DO)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:KULIK-CARLOS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5019 N MOZART ST
Mailing Address - Street 2:ATTN: SOULTANA AMAXOPOULOS
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3615
Mailing Address - Country:US
Mailing Address - Phone:773-293-3223
Mailing Address - Fax:
Practice Address - Street 1:4753 N ELSTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-4002
Practice Address - Country:US
Practice Address - Phone:773-205-7200
Practice Address - Fax:773-481-7577
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036128604207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036128604Medicaid
IL036128604Medicaid