MEDICARE: DR. FREDERICK M KULLMAN 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	78-202	NM
2	207Q00000X	Family Medicine Physician	78-202	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	202015408	OTHER		PRESBYTERIAN HEALTH PLAN
2	NM011553	OTHER	NM	BCBS NM
3	1699938	OTHER		UHC
4	10003854	OTHER		LOVELACE HEALTH PLAN
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	PROVP13502	OTHER		MOLINA
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649276981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDERICK M KULLMAN M.D.

Provider Business Mailing Address
First Line	:	433 SAINT MICHAELS DR
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-7601
Country	:	US
Telephone Number	:	505-988-1232
Fax Number	:

Provider Business Practice Location Address
First Line	:	433 SAINT MICHAELS DR
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-7601
Country	:	US
Telephone Number	:	505-988-1232
Fax Number	:	505-984-1603

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/08/2013

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Directions to “ DR. FREDERICK M KULLMAN M.D.” Practice Location

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