Provider Demographics
NPI:1063436392
Name:KULICK, ERIC MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:MICHAEL
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 1:8340 MISSION RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66206-1355
Mailing Address - Country:US
Mailing Address - Phone:913-642-0100
Mailing Address - Fax:913-642-0176
Practice Address - Street 1:8340 MISSION RD
Practice Address - Street 2:SUITE 210
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66206-1355
Practice Address - Country:US
Practice Address - Phone:913-642-0100
Practice Address - Fax:913-642-0176
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-184112084P0800X
MO1042062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS700616OtherBLUE SHIELD OF KANSAS
MO19566019OtherBLUE SHIELD OF KC
D05368Medicare UPIN
KS700616OtherBLUE SHIELD OF KANSAS