Individual provider Active NPI

John Robert Kulik, D.D.S.

  • General Practice Dentistry
  • Eastpointe, MI
National Provider Identifier
1154452480
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2901012581 Issued in MI
Practice address
22239 Gratiot Ave
Eastpointe, MI 48021-2228
Phone
(586) 778-6230
NPI assigned
Mar 8, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 2901012581 MI Primary

Addresses

Primary practice location

22239 Gratiot Ave
Eastpointe, MI 48021-2228

Mailing address

983 Fisher Rd
Grosse Pointe Park, MI 48230-1204
Phone (313) 884-4139

Other identifiers 1

IdentifierTypeStateIssuer
4063582MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160127001060 MI Order and Referring Only - DentistPractitioner - Dentist 8820391709

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2901012581MIMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1154452480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "983 FISHER RD",
            "city": "GROSSE POINTE PARK",
            "state": "MI",
            "postal_code": "482301204",
            "telephone_number": "313-884-4139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22239 GRATIOT AVE",
            "city": "EASTPOINTE",
            "state": "MI",
            "postal_code": "480212228",
            "telephone_number": "586-778-6230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KULIK",
        "first_name": "JOHN",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901012581",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4063582",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eastpointe, MI

Sources for this page

Verify at the official NPI Registry.