Provider Demographics
NPI:1487615928
Name:KULIK, JANICE ELAINE (MD)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:ELAINE
Last Name:KULIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 N GREENWOOD ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2644
Mailing Address - Country:US
Mailing Address - Phone:719-545-5297
Mailing Address - Fax:719-583-9682
Practice Address - Street 1:1619 N GREENWOOD ST
Practice Address - Street 2:SUITE 106
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2644
Practice Address - Country:US
Practice Address - Phone:719-545-5297
Practice Address - Fax:719-583-9682
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26132207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COMA0126132Medicaid
CO50821Medicare PIN
COE75708Medicare UPIN