Provider Demographics
NPI:1841308574
Name:KULIG, JOHN W (MD, MPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:KULIG
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 WASHINGTON ST
Mailing Address - Street 2:NEMC BOX 836
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1526
Mailing Address - Country:US
Mailing Address - Phone:617-636-7105
Mailing Address - Fax:617-636-6204
Practice Address - Street 1:750 WASHINGTON ST
Practice Address - Street 2:NEMC BOX 479
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1526
Practice Address - Country:US
Practice Address - Phone:617-636-4779
Practice Address - Fax:617-636-7719
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA39576208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2075679Medicaid
MAK19124Medicare ID - Type Unspecified
MAF04267Medicare UPIN