Provider Demographics
NPI:1699966051
Name:SOOD, KUL (MD)
Entity type:Individual
Prefix:MR
First Name:KUL
Middle Name:
Last Name:SOOD
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 1:95 S CHICAGO ST
Mailing Address - Street 2:WILL COUNTY ADULT DELENTION FACILTY
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60436
Mailing Address - Country:US
Mailing Address - Phone:815-740-5561
Mailing Address - Fax:
Practice Address - Street 1:95 S CHICAGO ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60436
Practice Address - Country:US
Practice Address - Phone:815-740-5561
Practice Address - Fax:815-740-5577
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL96147Medicare PIN
ILH77482Medicare UPIN