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General NPI Number Information
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NPI Number | 1154652576
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Entity Type | Organization
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Legal Business Name | MARINA V KULICK MD PLC
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Dates
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Enumeration Date | 01/25/2010
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Last Update Date | 02/25/2015
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Provider Practice Location Address
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Address Line | 1744 S PINELLAS AVE
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City | TARPON SPRINGS
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State | FL
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Zip | 34689-1939
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Country | US
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Telephone | 727-940-3478
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Fax | 727-940-3480
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Provider Business Mailing Address
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Address Line | 1744 S PINELLAS AVE
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City | TARPON SPRINGS
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State | FL
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Zip | 34689-1939
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Country | US
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Telephone | 727-940-3478
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Fax | 727-940-3480
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Authorized Official
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Title or Position | DIRECTOR/PRESIDNT
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Name | MARINA V KULICK
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Credential | M.D.
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Telephone | 727-940-3478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0500X
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Taxonomy Name | Preventive Medicine/Occupational Environmental Medicine Physician
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License Number | ME103499
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME103499
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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