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General NPI Number Information
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NPI Number | 1639631880
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Entity Type | Individual
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Provider Name | BRIAN WILLIAM KULICK MD
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Gender | Male
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Dates
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Enumeration Date | 04/04/2019
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Last Update Date | 08/25/2022
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Provider Practice Location Address
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Address Line | 13001 E 17TH PL
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City | AURORA
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State | CO
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Zip | 80045-2570
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Country | US
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Telephone | 303-724-9903
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 110429
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City | AURORA
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State | CO
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Zip | 80042-0429
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Country | US
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Telephone |
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Fax |
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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 | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 0068344
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | DR.0068344
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License Number State | CO
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