Healthcare Provider Details

I. General information

NPI: 1841295342
Provider Name (Legal Business Name): ANNMARIE KULEKOWSKIS DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 N FRANCISCO AVE # 203
CHICAGO IL
60622-2743
US

IV. Provider business mailing address

3400 W 111TH ST # 123
CHICAGO IL
60655-3330
US

V. Phone/Fax

Practice location:
  • Phone: 773-824-6703
  • Fax:
Mailing address:
  • Phone: 773-248-4111
  • Fax: 773-248-4450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016005127
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: