Basic Information
Provider Information
NPI: 1043411333
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KULIN
FirstName: WENDI
MiddleName: IRENE
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9110 COLLEGE POINTE CT
Address2:  
City: FORT MYERS
State: FL
PostalCode: 339193244
CountryCode: US
TelephoneNumber: 2392082206
FaxNumber:  
Practice Location
Address1: 9110 COLLEGE POINTE CT
Address2:  
City: FORT MYERS
State: FL
PostalCode: 339193244
CountryCode: US
TelephoneNumber: 2392082206
FaxNumber: 5206940235
Other Information
ProviderEnumerationDate: 05/31/2007
LastUpdateDate: 11/08/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/08/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084N0400X22385NHN Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
2084N0400XME155584FLN Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
2084N0400X107264MTN Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
2084N0400XMD478066PAN Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
2084N0400X76566AZY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology

No ID Information.


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