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General NPI Number Information
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NPI Number | 1215499249
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Entity Type | Individual
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Provider Name | JACQUELYN MICHELLE KUKULSKI DO
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Gender | Female
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Dates
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Enumeration Date | 04/01/2019
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 10240 CALUMET AVE FL 2
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City | MUNSTER
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State | IN
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Zip | 46321-4082
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Country | US
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Telephone | 219-922-9150
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Fax | 219-922-9180
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Provider Business Mailing Address
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Address Line | 8558 BROADWAY
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City | MERRILLVILLE
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State | IN
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Zip | 46410-7032
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Country | US
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Telephone | 219-392-7084
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Fax | 219-703-6854
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 125.074969
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036.157681
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 02007548A
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License Number State | IN
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