Provider Demographics
NPI:1225207699
Name:KULAS, JULIE CYNTHIA (PAC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:CYNTHIA
Last Name:KULAS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:CYNTHIA
Other - Last Name:HECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:3400 W 66TH ST
Mailing Address - Street 2:SUITE 350
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2111
Mailing Address - Country:US
Mailing Address - Phone:952-832-0805
Mailing Address - Fax:952-832-5597
Practice Address - Street 1:303 E NICOLLET BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4522
Practice Address - Country:US
Practice Address - Phone:952-435-4140
Practice Address - Fax:952-435-4189
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10405363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN10405OtherMINNESOTA MEDICAL LICENSE
MNMH1740477OtherDEA