Basic Information
| Provider Information | |||||||||
| NPI: | 1558351049 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KULWICKI | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4780 N JOSEY LN | ||||||||
| Address2: | |||||||||
| City: | CARROLLTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750104615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724921334 | ||||||||
| FaxNumber: | 9724925174 | ||||||||
| Practice Location | |||||||||
| Address1: | 4780 N JOSEY LN | ||||||||
| Address2: | |||||||||
| City: | CARROLLTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750104615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724921334 | ||||||||
| FaxNumber: | 9724925174 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2005 | ||||||||
| LastUpdateDate: | 02/01/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 39357 | WI | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 43358 | KY | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0005X | P7141 | TX | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3810017020 | 05 | WV | MEDICAID | 7100109090 | 05 | KY | MEDICAID | 3041952 | 05 | OH | MEDICAID | P00852990 | 01 | KY | RR MEDICARE | OTHER |