Provider Demographics
NPI:1316908775
Name:KULHANEK, JAN (MD)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:
Last Name:KULHANEK
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:PO BOX 230757
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92023-0757
Mailing Address - Country:US
Mailing Address - Phone:760-944-7300
Mailing Address - Fax:760-633-3949
Practice Address - Street 1:320 SANTA FE DR
Practice Address - Street 2:SUITE 204
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5138
Practice Address - Country:US
Practice Address - Phone:760-944-7300
Practice Address - Fax:760-633-3949
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44646207RC0000X
VA0101241881207RC0000X
CAA102299207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34270100Medicaid
AQ949Medicare PIN
H68857Medicare UPIN
WI046B15875Medicare ID - Type Unspecified