MEDICARE: MR. MICHAEL KULIKOWSKI

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	363AM0700X	Medical Physician Assistant	PA-2006-0019	NM
2	363A00000X	Physician Assistant	PA2006-0019	NM

General Provider Information

NPI Number	:	1205968856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL KULIKOWSKI

Provider Business Mailing Address
First Line	:	800 BRADBURY DR SE STE 116
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4310
Country	:	US
Telephone Number	:	505-272-1476
Fax Number	:

Provider Business Practice Location Address
First Line	:	6400 PASEO DEL NORTE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87113-1718
Country	:	US
Telephone Number	:	505-596-2100
Fax Number	:

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

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	08/07/2025

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