Healthcare Provider Details

I. General information

NPI: 1770511669
Provider Name (Legal Business Name): THOMAS ANDREW GULICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 01/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 GRAMMONT STREET; SUITE 402
MONROE LA
71201
US

IV. Provider business mailing address

312 GRAMMONT STREET; SUITE 402
MONROE LA
71201
US

V. Phone/Fax

Practice location:
  • Phone: 318-966-6550
  • Fax: 318-966-6551
Mailing address:
  • Phone: 318-966-6550
  • Fax: 318-966-6551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number014119
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: