Basic Information
| Provider Information | |||||||||
| NPI: | 1801033550 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KULICK | ||||||||
| FirstName: | MARINA | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | M.D.,MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5400 PINEHURST DR | ||||||||
| Address2: | |||||||||
| City: | SPRING HILL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346063833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522775348 | ||||||||
| FaxNumber: | 3526062857 | ||||||||
| Practice Location | |||||||||
| Address1: | 7505 ROTTINGHAM RD | ||||||||
| Address2: | |||||||||
| City: | PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346682648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274955190 | ||||||||
| FaxNumber: | 7278623193 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2009 | ||||||||
| LastUpdateDate: | 09/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083P0901X | ME103499 | FL | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Public Health & General Preventive Medicine | 2083X0100X | ME103499 | FL | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine | 208D00000X | ME103499 | FL | N | Allopathic & Osteopathic Physicians | General Practice | 207Q00000X | ME103499 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001860000 | 05 | FL | MEDICAID |