=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093034456
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL L KULA PSY D S.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2010
-----------------------------------------------------
Last Update Date | 05/25/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2801 W KINNICKINNIC RIVER PKWY SUITE 347
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53215-3669
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-385-2877
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 510058
-----------------------------------------------------
City | NEW BERLIN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53151-0058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-385-2877
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING
-----------------------------------------------------
Name | JANE K HANSEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 262-363-9917
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 1433
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------