Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | R7229 | MO |
NPI | 1104843630 |
---|---|
Provider Name | Dr. Anthony Kulczycki JR. |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Saint Louis, MO 63110-1392 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 15/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200869501 | (05) | MO |