MEDICARE: LILLIAN KENDALL KULIK PA-C

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	363A00000X	Physician Assistant	PA9120408	FL

General Provider Information

NPI Number	:	1821983826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILLIAN KENDALL KULIK PA-C

Provider Business Mailing Address
First Line	:	4077 CORDOVA AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-6020
Country	:	US
Telephone Number	:	904-485-6469
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 3RD ST S STE 200
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-6097
Country	:	US
Telephone Number	:	904-249-6110
Fax Number	:

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

Provider Enumeration Date	:	06/10/2025
Last Update Date	:	08/19/2025

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