Healthcare Provider Details

I. General information

NPI: 1750132544
Provider Name (Legal Business Name): PHILLIP KULPINSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2024
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

3410 N LAKE SHORE DR
CHICAGO IL
60657-2813
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-5682
  • Fax:
Mailing address:
  • Phone: 708-253-5642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: