Healthcare Provider Details

I. General information

NPI: 1184043473
Provider Name (Legal Business Name): ALEXANDER KULEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 READING RD STE 220
CINCINNATI OH
45202-1439
US

IV. Provider business mailing address

2799 W GRAND BLVD
DETROIT MI
48202-2608
US

V. Phone/Fax

Practice location:
  • Phone: 513-381-1900
  • Fax: 513-287-6403
Mailing address:
  • Phone: 800-653-6568
  • Fax: 313-916-1327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number54274
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4301115075
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35.139513
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: