Healthcare Provider Details

I. General information

NPI: 1063646842
Provider Name (Legal Business Name): ROBERT JOSEPH KULL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2009
Last Update Date: 05/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E FLORENCE BLVD
CASA GRANDE AZ
85222-5303
US

IV. Provider business mailing address

1800 E FLORENCE BLVD
CASA GRANDE AZ
85222-5303
US

V. Phone/Fax

Practice location:
  • Phone: 520-381-6559
  • Fax: 520-381-6019
Mailing address:
  • Phone: 520-381-6559
  • Fax: 520-381-6019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0879
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: