Provider Demographics
NPI:1730148065
Name:GULICK, ARTHUR W (MD)
Entity type:Individual
Prefix:
First Name:ARTHUR
Middle Name:W
Last Name:GULICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 N SHELDON RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1524
Mailing Address - Country:US
Mailing Address - Phone:734-459-3930
Mailing Address - Fax:734-459-0749
Practice Address - Street 1:221 N SHELDON RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1524
Practice Address - Country:US
Practice Address - Phone:734-459-3930
Practice Address - Fax:734-459-0749
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI035213207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2103802Medicaid
MI2103802Medicaid
MI0828144Medicare ID - Type Unspecified