Healthcare Provider Details

I. General information

NPI: 1265346670
Provider Name (Legal Business Name): VICKTREE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4108 BLUE HOLLOW DR
COLUMBIA MO
65203-7256
US

IV. Provider business mailing address

500 MARKET ST
FULTON MO
65251-2808
US

V. Phone/Fax

Practice location:
  • Phone: 216-299-2522
  • Fax:
Mailing address:
  • Phone: 573-219-0858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. GAURAV KULKARNI
Title or Position: CEO
Credential: MD
Phone: 513-219-0858