MEDICARE: JANUS KULPA 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	207Q00000X	Family Medicine Physician	14877	MS

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

General Provider Information

NPI Number	:	1891833828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANUS KULPA M.D.

Provider Business Mailing Address
First Line	:	1408 HELLMERS LN
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-4938
Country	:	US
Telephone Number	:	228-872-5453
Fax Number	:

Provider Business Practice Location Address
First Line	:	3434 BIENVILLE BLVD
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-5732
Country	:	US
Telephone Number	:	228-875-1599
Fax Number	:

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/08/2007

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