MEDICARE: DR. ALEXANDER KULEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	54274	KY
2	207W00000X	Ophthalmology Physician	4301115075	MI
3	207W00000X	Ophthalmology Physician	35.139513	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184043473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER KULEY M.D.

Provider Business Mailing Address
First Line	:	2799 W GRAND BLVD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-2608
Country	:	US
Telephone Number	:	800-653-6568
Fax Number	:	313-916-1327

Provider Business Practice Location Address
First Line	:	2055 READING RD STE 220
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-1439
Country	:	US
Telephone Number	:	513-381-1900
Fax Number	:	513-287-6403

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2014
Last Update Date	:	02/14/2022

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