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General NPI Number Information
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NPI Number | 1316293673
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Entity Type | Organization
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Legal Business Name | DANIEL KULICK DO, P.C.
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Dates
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Enumeration Date | 07/24/2012
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 43171 DALCOMA DR SUITE 7
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-6307
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Country | US
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Telephone | 586-846-3701
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Fax |
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Provider Business Mailing Address
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Address Line | 43171 DALCOMA DR SUITE 7
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-6307
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Country | US
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Telephone | 586-846-3701
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Fax |
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Authorized Official
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Title or Position | PRESIDENT / PHYSICIAN OWNER
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Name | DANIEL KULICK
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Credential | DO
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Telephone | 586-846-3701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 5101016234
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101016234
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License Number State | MI
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