MEDICARE: DEBRA GULYANICS DO

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	207P00000X	Emergency Medicine Physician	3054	AZ
2	207Q00000X	Family Medicine Physician	3054	AZ
3	207Q00000X	Family Medicine Physician	02003656A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P01723956	OTHER	IN	RR MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1376597302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA GULYANICS DO

Provider Business Mailing Address
First Line	:	307 WESTERN DR
Second Line	:
City	:	CHESTERFIELD
State	:	IN
Zip	:	46017-1230
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	307 WESTERN DR
Second Line	:
City	:	CHESTERFIELD
State	:	IN
Zip	:	46017-1230
Country	:	US
Telephone Number	:	928-566-7460
Fax Number	:

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

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	10/29/2019

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Directions to “ DEBRA GULYANICS DO” Practice Location

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