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NPI Code Detail

MEDICARE: DR. JANIS J. GULICK MD

MEDICARE: DR. JANIS J. GULICK MD
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
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician14579LA

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 : 1700874245
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JANIS J. GULICK MD
Provider Business Mailing Address
First Line : PO BOX 731280
Second Line :
City : DALLAS
State : TX
Zip : 75373-1280
Country : US
Telephone Number : 318-841-9532
Fax Number :
Provider Business Practice Location Address
First Line : 2915 MISSOURI AVE
Second Line :
City : SHREVEPORT
State : LA
Zip : 71109-4327
Country : US
Telephone Number : 318-364-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2005
Last Update Date : 04/04/2012

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