Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 35034609 | OH |
NPI | 1033197488 |
---|---|
Provider Name | John D. Chulik |
First Address | Lake City, FL 32025-5808 |
Second Address | Lake City, FL 32025-5808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2006 |
Last Update Date | 05/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C01310 | (02) | OH |