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General NPI Number Information
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NPI Number | 1053378034
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Entity Type | Individual
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Provider Name | DIANE ALICE CULIK MD
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Gender | Female
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 01/03/2023
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Provider Practice Location Address
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Address Line | 2644 FLORLEN AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-3968
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Country | US
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Telephone | 855-669-9355
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Fax | 888-480-3870
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Provider Business Mailing Address
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Address Line | 2644 FLORLEN AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-3968
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Country | US
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Telephone | 313-443-1306
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Fax | 888-480-3870
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 038399
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License Number State | MI
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