Healthcare Provider Details

I. General information

NPI: 1154388056
Provider Name (Legal Business Name): JOSEPH KULPEKSA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 DRINKWATER RD
BAY ST LOUIS MS
39520-1658
US

IV. Provider business mailing address

149 DRINKWATER RD
BAY ST LOUIS MS
39520-1658
US

V. Phone/Fax

Practice location:
  • Phone: 228-467-8600
  • Fax:
Mailing address:
  • Phone: 573-359-2930
  • Fax: 573-359-1304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberE2296
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number117451
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE-2296
License Number StateAR
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25600
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: