Provider Demographics
NPI:1558311738
Name:KULCZYCKI, TED JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:TED
Middle Name:JOSEPH
Last Name:KULCZYCKI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28594 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1285
Mailing Address - Country:US
Mailing Address - Phone:630-859-6800
Mailing Address - Fax:
Practice Address - Street 1:2500 W FABYAN PKWY
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-1572
Practice Address - Country:US
Practice Address - Phone:630-879-2110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086232207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036086232Medicaid
IL1558311738OtherNPI DR. TED KULCZYCKI
IL1558311738OtherNPI DR. TED KULCZYCKI
IL036086232Medicaid
ILK28266Medicare PIN
IL1235181488OtherNPI, ORGANIZATION
ILK28266Medicare PIN
IL213698Medicare PIN