Healthcare Provider Details

I. General information

NPI: 1841308574
Provider Name (Legal Business Name): JOHN W KULIG MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 WASHINGTON ST NEMC BOX 479
BOSTON MA
02111-1526
US

IV. Provider business mailing address

750 WASHINGTON ST NEMC BOX 836
BOSTON MA
02111-1526
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-4779
  • Fax: 617-636-7719
Mailing address:
  • Phone: 617-636-7105
  • Fax: 617-636-6204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number39576
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number39576
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: