Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | ME0041506 | FL |
N | 207NS0135X | Procedural Dermatology | ME0041506 | FL |
NPI | 1255545547 |
---|---|
Provider Name | John Alan Kulick |
First Address | Boca Raton, FL 33427-3606 |
Second Address | Boca Raton, FL 33433-3802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D63779 | (02) |