Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | PO3308 | FL |
Y | 222Z00000X | Podiatrist | PO3308 | FL |
NPI | 1023016987 |
---|---|
Provider Name | Samuel D Kulick |
First Address | Jacksonville, FL 32216-4250 |
Second Address | Jacksonville, FL 32216-4250 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 11/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
65978 | BCBS (01) | FL |
P00784166 | RAILROAD MEDICARE (01) |