=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669423430
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CLARK C KULIG MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2006
-----------------------------------------------------
Last Update Date | 02/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2535 S DOWNING ST STE 380
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80210-5850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-778-5797
-----------------------------------------------------
Fax | 303-778-5205
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2535 S DOWNING ST STE 380
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80210-5850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-778-5797
-----------------------------------------------------
Fax | 303-778-5205
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | DR.39951
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------