Healthcare Provider Details

I. General information

NPI: 1295709533
Provider Name (Legal Business Name): KENNETH J KULIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49310 VAN DYKE AVE
SHELBY TOWNSHIP MI
48317-1337
US

IV. Provider business mailing address

43411 GARFIELD RD STE B
CLINTON TOWNSHIP MI
48038-1152
US

V. Phone/Fax

Practice location:
  • Phone: 586-731-8900
  • Fax: 586-731-7762
Mailing address:
  • Phone: 586-731-8900
  • Fax: 586-731-7762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301042847
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: