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NPI Code Detail

MEDICARE: KARIN I KULTGEN M.D.

MEDICARE: KARIN I KULTGEN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician27699WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093788309
Entity Type Code : Individual
Provider Name (Legal Business Name) : KARIN I KULTGEN M.D.
Provider Business Mailing Address
First Line : N17W24100 RIVERWOOD DR STE 250
Second Line : PROHEALTH CARE MEDICAL ASSOCIATES INC.
City : WAUKESHA
State : WI
Zip : 53188-1177
Country : US
Telephone Number : 262-928-4100
Fax Number : 262-928-5835
Provider Business Practice Location Address
First Line : 1500 WALNUT RIDGE DR
Second Line : PROHEALTH CARE MEDICAL ASSOCIATES INC.
City : HARTLAND
State : WI
Zip : 53029-9317
Country : US
Telephone Number : 262-928-7500
Fax Number : 262-367-8744
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2006
Last Update Date : 11/15/2011

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