1851725410 NPI number — DR. ANDRE ALEXANDER KULISZ PHD, ND, ACN

Table of content: DR. ANDRE ALEXANDER KULISZ PHD, ND, ACN (NPI 1851725410)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851725410 NPI number — DR. ANDRE ALEXANDER KULISZ PHD, ND, ACN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KULISZ
Provider First Name:
ANDRE
Provider Middle Name:
ALEXANDER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, ND, ACN
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851725410
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 63794
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PIPE CREEK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78063-3794
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-398-0252
Provider Business Mailing Address Fax Number:
661-459-2329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1647 RIO RANCHERO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEHILLS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78063-6090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-398-0252
Provider Business Practice Location Address Fax Number:
661-459-2329
Provider Enumeration Date:
08/30/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 175F00000X , with the licence number:  NOT REGULATED IN TX , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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