| Jacquelyn Michelle Kukulski, DO | |
|
10240 Calumet Ave Fl 2, Munster, IN 46321-4082 | |
| (219) 922-9150 | |
| (219) 922-9180 |
| Full Name | Jacquelyn Michelle Kukulski |
|---|---|
| Gender | Female |
| Speciality | Pediatrics |
| Location | 10240 Calumet Ave Fl 2, Munster, Indiana |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215499249 | NPI | - | NPPES |
| 300083601 | Medicaid | IN | |
| 1103769274 | Other | IN | ANTHEM |
| 390200000X | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208000000X | Pediatrics | 125.074969 (Illinois) | Secondary |
| 208000000X | Pediatrics | 036.157681 (Illinois) | Secondary |
| 208000000X | Pediatrics | 02007548A (Indiana) | Primary |
| Entity Name | Community Care Network Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1457610487 PECOS PAC ID: 3678737012 Enrollment ID: O20120614000331 |
| Mailing Address | Practice Location Address |
|---|---|
| Jacquelyn Michelle Kukulski, DO 8558 Broadway, Merrillville, IN 46410-7032 Ph: (219) 392-7084 | Jacquelyn Michelle Kukulski, DO 10240 Calumet Ave Fl 2, Munster, IN 46321-4082 Ph: (219) 922-9150 |
Mrs. Azra Shibli Sheriff, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 9128 Columbia Ave, Ste A, Munster, IN 46321 Phone: 219-836-2730 Fax: 219-836-0244 | |
Linda T Chan, M.D Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 800 Macarthur Blvd, Ste 21, Munster, IN 46321 Phone: 219-836-1163 Fax: 219-836-0588 | |
Dr. Eric Heinert, D.O. Pediatrics Medicare: Medicare Enrolled Practice Location: 9126 Columbia Ave, Munster, IN 46321 Phone: 219-836-1600 | |
Dr. Erica Lynne Yamout, D.O. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 1946 45th Ave, Munster, IN 46321 Phone: 219-924-7794 | |
Dr. Robert H. Wadle, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 7905 Calumet Ave, Hammond Clinic Llc, Munster, IN 46321 Phone: 219-836-7214 Fax: 219-934-9816 | |
Wichest Boonyapredee, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 901 Macarthur Blvd, Neonatology Department, Munster, IN 46321 Phone: 219-836-2022 |