MEDICARE: DR. MICHAEL ANTHONY KULUZ 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
1	174400000X	Specialist	10943	NV
2	2080N0001X	Neonatal-Perinatal Medicine Physician	MD60516236	WA

General Provider Information

NPI Number	:	1295785236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL ANTHONY KULUZ M.D.

Provider Business Mailing Address
First Line	:	770 THE CITY DRIVE SOUTH
Second Line	:	SUITE 4000
City	:	ORANGE
State	:	CA
Zip	:	92868-4929
Country	:	US
Telephone Number	:	800-463-6628
Fax Number	:	714-620-3008

Provider Business Practice Location Address
First Line	:	3196 S MARYLAND PKWY
Second Line	:	SUITE 217
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-2305
Country	:	US
Telephone Number	:	702-733-4944
Fax Number	:	702-733-6507

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	01/26/2015

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