Healthcare Provider Details

I. General information

NPI: 1114161874
Provider Name (Legal Business Name): TIMOTHY CHRISTOPHER KULIKOWSKI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2009
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 UNION ST STE 4
BANGOR ME
04401-8603
US

IV. Provider business mailing address

63 BENNOCH RD
ORONO ME
04473-3623
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-8030
  • Fax: 207-973-8662
Mailing address:
  • Phone: 607-237-4399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberDO2297
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO2297
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: