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General NPI Number Information
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NPI Number | 1447596267
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Entity Type | Organization
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Legal Business Name | GREGORY A. KULDANEK P.C.
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Dates
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Enumeration Date | 12/26/2012
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Last Update Date | 12/26/2012
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Provider Practice Location Address
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Address Line | 2320 E BELTLINE AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-5906
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Country | US
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Telephone | 616-949-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 185 MARYLAND AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-3935
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Country | US
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Telephone | 616-307-6060
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GREGORY A. KULDANEK
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Credential | M.D.
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Telephone | 616-822-1821
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301047564
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License Number State | MI
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