Healthcare Provider Details

I. General information

NPI: 1326065566
Provider Name (Legal Business Name): TEOFIL B KULYK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 SOUTHERN OAKS DR
PLANT CITY FL
33563-1451
US

IV. Provider business mailing address

540 MEDICAL OAKS AVE STE 103
BRANDON FL
33511-5995
US

V. Phone/Fax

Practice location:
  • Phone: 813-754-1869
  • Fax: 813-759-8570
Mailing address:
  • Phone: 813-684-2211
  • Fax: 813-655-7669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME36487
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: