Individual
DR. SLAVA I KULAKOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
134 ROUND HILL RD, FAIRFIELD, CT 06824
(203) 255-0695
(203) 255-0629
Mailing address
765 MAIN ST, STE 100, MONROE, CT 06468-2810
(203) 255-0695
(203) 255-0629
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036896
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001368960
—
CT
01
—
010036896CT01
BCBS
CT
01
—
OV4890
HEALTHNET
CT
Enumeration date
08/11/2006
Last updated
06/25/2019
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