Healthcare Provider Details

I. General information

NPI: 1487062741
Provider Name (Legal Business Name): IRYNA KULYK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2014
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 BEACON PKWY
GRANGER IN
46530-7196
US

IV. Provider business mailing address

3245 HEALTH DR
GRANGER IN
46530-1380
US

V. Phone/Fax

Practice location:
  • Phone: 574-999-8788
  • Fax: 574-999-8781
Mailing address:
  • Phone: 574-647-3725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01080914A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number01080914A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number290275
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.064370
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: