Healthcare Provider Details

I. General information

NPI: 1316293673
Provider Name (Legal Business Name): DANIEL KULICK DO, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2012
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43171 DALCOMA DR SUITE 7
CLINTON TOWNSHIP MI
48038-6307
US

IV. Provider business mailing address

43171 DALCOMA DR SUITE 7
CLINTON TOWNSHIP MI
48038-6307
US

V. Phone/Fax

Practice location:
  • Phone: 586-846-3701
  • Fax:
Mailing address:
  • Phone: 586-846-3701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101016234
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number5101016234
License Number StateMI

VIII. Authorized Official

Name: DANIEL KULICK
Title or Position: PRESIDENT / PHYSICIAN OWNER
Credential: DO
Phone: 586-846-3701