MEDICARE: DR. DANIEL TIMOTHY KULICK 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	207Q00000X	Family Medicine Physician	5101016234	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5101016234	OTHER	MI	LICENSE
2	5315024530	OTHER	MI	CONTROLLED SUBSTANCE LICENSE
3	11762285	OTHER	MI	CAQH ID
4	1376695205	OTHER	MI	GROUP NPI

General Provider Information

NPI Number	:	1720206600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL TIMOTHY KULICK DO

Provider Business Mailing Address
First Line	:	4472 MAIN ST
Second Line	:
City	:	BROWN CITY
State	:	MI
Zip	:	48416-7908
Country	:	US
Telephone Number	:	810-346-2751
Fax Number	:

Provider Business Practice Location Address
First Line	:	4472 MAIN ST
Second Line	:
City	:	BROWN CITY
State	:	MI
Zip	:	48416-7908
Country	:	US
Telephone Number	:	810-346-2751
Fax Number	:

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

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	03/07/2023

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