Active NPI
Eric Michael Kulick, M.D.
- Psychiatry Physician
- Prairie Village, KS
National Provider Identifier
1063436392
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 04-18411
- Practice address
- 8340 Mission Rd
Suite 210
Prairie Village, KS 66206-1355 - Phone
- (913) 642-0100
- Fax
- (913) 642-0176
- NPI assigned
- Jul 27, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 04-18411 | KS | Primary |
| Psychiatry Physician | 2084P0800X | 104206 | MO |
Addresses
Primary practice location
8340 Mission Rd
Suite 210
Prairie Village, KS 66206-1355
Mailing address
8340 Mission Rd
Suite 210
Prairie Village, KS 66206-1355
Phone (913) 642-0100
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 700616 | Other | KS | BLUE SHIELD OF KANSAS |
| 19566019 | Other | MO | BLUE SHIELD OF KC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Apr 1, 2010 through Apr 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04-18411 | KS | MD | Psychiatry Physician |
| 104206 | MO | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1063436392",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8340 MISSION RD",
"address_2": "SUITE 210",
"city": "PRAIRIE VILLAGE",
"state": "KS",
"postal_code": "662061355",
"telephone_number": "913-642-0100",
"fax_number": "913-642-0176"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8340 MISSION RD",
"address_2": "SUITE 210",
"city": "PRAIRIE VILLAGE",
"state": "KS",
"postal_code": "662061355",
"telephone_number": "913-642-0100",
"fax_number": "913-642-0176"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KULICK",
"first_name": "ERIC",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "KS",
"license": "04-18411",
"primary": true
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MO",
"license": "104206",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD OF KANSAS",
"identifier": "700616",
"state": "KS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD OF KC",
"identifier": "19566019",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Prairie Village, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.