Provider Demographics
NPI:1891902151
Name:KULIG, JESSE LAUREN (DO)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:LAUREN
Last Name:KULIG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JESSE
Other - Middle Name:LAUREN
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2050 S FINLEY RD
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4837
Mailing Address - Country:US
Mailing Address - Phone:630-819-5600
Mailing Address - Fax:
Practice Address - Street 1:2050 S FINLEY RD
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4837
Practice Address - Country:US
Practice Address - Phone:630-819-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036119053207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL400480Medicare PIN